Ep. 35: Erica Meloe – Solve the Pain Puzzle and Discover the True Source of Your Pain

00:00 – excerpt from the episode
01:13 – intro (listen to discover a little more about your host. Martin will tell you a new lesser-known fact about Dr. Maya)

01:51
Dr. Maya Novak:
If you needed to choose, what would you say is better: knowing what to do, or knowing what not to do? I’m still amazed when I hear stories from people whose doctors don’t even prescribe physiotherapy after an injury, because when it comes to recovery, there’s an enormous amount of value in knowing what to do – and also knowing what to avoid doing.
In 2019, Dr. Lissa Rankin introduced me to Erica Meloe, a physiotherapist who does her job with tons of passion. We did an interview that year and then another one in 2020 on my Mindful Injury Recovery World Summit. This episode is the second interview we did where we talked about very important things for patients, such as what to talk to your physiotherapist about (especially if you feel like you’re not getting results), and the important questions to ask when choosing the right physiotherapist for your injury, besides so many other things. I’m sure you’ll find this talk very valuable. Enjoy.

02:54
Dr. Maya Novak:
In this interview, I’m joined by Erica Meloe, who is a Board Certified Physiotherapist, and the author of the book, Why Do I Hurt?: Discover the Surprising Connections That Cause Physical Pain and What to Do About Them. She is also a co-host of the podcast Tough to Treat: A Physiotherapists' Guide to Managing Those Complex Patients. She specializes in treating patients with persistent unresolved pain and a really interesting part of her story is that for a decade, she solved unique financial puzzles on Wall Street, and now she utilizes those same strengths to help get of her patient’s pain so they can live their lives on their own terms. Erica, thank you so much for being here.

03:40
Erica Meloe:
Thank you so much for having me, Maya. It’s great to see you again.

03:43
Dr. Maya Novak:
Oh, I am so excited about this interview. We talked a bit about what we’re going to be talking about with pain, and it’s going to be juicy. Now, before we go there, can you share a bit about yourself and actually, what was so fascinating about physiotherapy that you decided to go down that route?

04:03
Erica Meloe:
So, my background is a little different. I graduated with your typical Bachelors’ degree with a degree in mathematics, and then I went to Spain and lived in Madrid for a year, and came back and received my MBA at NYU Stern School of Business. I worked for 10 years on Wall Street, and about the seventh year in, I was like, you know, I don’t think I want to retire on a trading floor. So, I went to school at night for a degree in exercise physiology because I had taken some Continuing Ed. courses on the weekend and there was a physical therapist in that program. She was like you like to figure things out, why don’t you – you like anatomy, you like the body. Why don’t you look into physical therapy? And I said, oh. I didn’t know what it was and had never needed it, and now I do it all the time, it’s crazy. But I said okay, and I so I looked into it and I decided to apply to schools many years ago and I’m so glad I came into the field because it really – it’s not so different from working with – you’re still working with clients. You’re figuring out and solving their pain problems or pain puzzles in my case. And on Wall Street, I was working and figuring out really how to make money for people, but I was using my problem solving and my learner strength. And for me, that’s what really drew me into it, looking at the body, and figuring out the connections and the relationships. That’s really what I love about the profession.

05:33
Dr. Maya Novak:
Yes, and you are amazing in regards to solving pain, and that’s why I’m so excited about this conversation. Now, what kind of role actually does our nervous play in recovery, and how does a, so to say, excited nervous system affect healing?

05:58
Erica Meloe:
So, it depends on how long I think you’ve had your symptoms, and whether the person is – I call them a coper or a non-coper, and I think that the nervous system – so, for example, if you’re under a lot of stress, it could be whatever stress. It could be physical stress, emotional stress, mental, it obviously increases the cortisol in your system, and that cortisol inhibits Substance P. Substance P is a chemical or neuropeptide that comes to our defense when we have increased stress, when we have pain, for instance. Pain is a stressor, and our nervous system is smart. It sends out these neuro-peptides to help us. But, when you have increased cortisol in your system because of stress to our nervous system, it deactivates that or inactivates it, or lessens the effect of your pain reducing mechanisms. So, our nervous system, it is smart in that regard, but if we have chronic, chronic stress, which people have when they have persistent pain, that really lowers your defense mechanism and I think in terms of - the answer to that, is really about how we manage stress. Also, with regards to the nervous system, our brains are really smart. So, if we can tell it – like I can tell a patient, when you squat, you’re shifting to the right. And they’re like I didn’t know that and if I think that’s relevant because a foot issue they’re offloading their painful side for years, right. You make them aware of it, put them in front of a mirror, and their nervous systems figure it out. So that, is a way, our nervous systems really, really help us. But some people have very sensitive systems and you have to manage that a bit differently.

08:01
Dr. Maya Novak:
Can we talk a bit more about this stress because here’s the thing. Usually, what we think about if something is stressful, we visualize or see ourselves in traffic or with a boss over our shoulders or something that is more like a major thing. However, can we talk also a bit about how perhaps searching online can contribute to stress as well? Because when we get injured, many times I hear stories about then I went online and I searched everything, and I went through all the medical journals and all of the blog posts and stories and everything. Can we talk a bit about this?

08:47
Erica Meloe:
Yes, for sure. I always say Dr. Google, right, and because it’s unregulated people can put out their own stories of how I got better by doing this, and I got better by doing that. Everybody is so different, and what works for your friend may not work for you. I do think that, especially the internet and even non-internet, even people just showing us pictures of bulging discs or that photos where the person’s touching their back and you’re writhing in pain. Those are not helpful images for people because it lights your brain up. It lights part of your brain up that can potentially make your symptoms worse. If you are a better coper, if you can cope with looking at this, if you have coping skills that if you look a bulging disc and it doesn’t do anything to you, then you won’t be as effective. However, the more persistent your symptoms are, your brain undergoes changes, and you can feel that the minute you read something, it lights your brain up - but it’s like a vicious cycle. I always call it the orchestra that won’t stop playing. It goes over and over in your head. There’s always the saying, what you think about all day long, you will get. If you’re thinking about pain all day long, you’re going to get pain all day long. People always say, I’ve had patients say – I’ll ask them, I’ll say, how did you feel – how is your sitting, how do you feel, how’s your back during sitting – if they come in and they have an issue with sitting. They’re like geez, I don’t know. I was distracted all day. I’m like there you go. It was fine when you were sitting. It is a common issue. Like when I’m distracted, I feel good. Yes, because your brain is focusing on something else that’s just as important to you, and they’re – it’s not focusing on the pain centers in your brain, and that is extremely common. That’s why I like distraction and mindfulness.

10:49
Dr. Maya Novak:
Yes. So, would you say that when we are distracted and we don’t feel that pain that much or we actually do not feel it, that perhaps then the reason behind that physical pain might not be of a physical nature, but something else? So, either mental or emotional and stress and so on?

11:13
Erica Meloe:
Yes, for sure. I mean, if you look at a model, like a basic holistic care model, the physical is one circle, right. That’s your acute ankle sprain. I ran down a street and I turned on my ankle. That’s obviously going to be hot and swollen – normal. But you’ve got the mental, emotional, cognitive, financial – they are all issues. Some people can’t afford to pay for physical therapy or they can’t afford care. That’s a stressor. It’s the same thing. It affects your pain levels. There’s support, your support systems. So, if you don’t have a strong support system, it will affect the person in the center of that puzzle. So, the person’s in the center, and you’ve got the physical, the emotional, the cognitive, the mental, the financial, your element of self-care. I mean, we could call it whatever. The longer you have your symptoms, the less – I wouldn’t say less important, but relatively speaking, the cognitive and emotional aspects are just as important.

12:21
Dr. Maya Novak:
Mhm. I love that you shared before in regards to also searching online and looking at the images because the internet can be an amazing thing, an amazing tool, and then it can be also not so good. I have my personal experience with that. Two to three years ago when I was diagnosed with hipercifosis, I joined – because I wanted to see how people are doing – I joined, I think it was a Facebook group. Goodness! I was in and out within a few days because I really noticed that my symptoms and my pain became worse.

13:04
Erica Meloe:
Yes. Because words can help, and words can hurt. I use this example, I think, in my book. If you tell somebody who has an arthritic knee, and you tell them you’ve got bone on bone and you need surgery, how do you think that’s person going to hear that? They’re going to forget that you need surgery. They’re going to hear bone on bone. The delivery mechanism matters. You say you have some arthritic changes in your knee. It’s very common in your age group. You may need surgery at some point, but let’s manage it. That’s the same message, but you did different delivery. When you’re looking online, it’s just words. So, it’s hard to have – you’re looking at words. You’re not looking at someone that’s saying things to you, and you can interpret them the way you want. I agree with you - Facebook groups, people just are uncensored! I mean, they just write and write and write, and I learned – my radar goes up, and I’m out. It’s just not helpful for me to read those things either.

14:07
Dr. Maya Novak:
Yes. So, as much as I know your story, you also have personal experience with pain. Is that correct?

14:14
Erica Meloe:
Yes. Yes, it’s funny, I’ve had many injuries, and more so since I’ve become a physical therapist, which is ironic because I sat for so many years on Wall Street and was literally sitting all day. I had some chronic back pain or persistent back pain and I didn’t really know what physical therapy was. But now, I’ve had multiple ankle sprains. I’ve had, let’s see, my left hip – I mean, I’ve had a lot. The chronic, the most persistent thing for me, is my neck. I’ve had a lot of issues over the years, and I can manage it, to be honest, but that has been the most persistent thing. I have found that my ankle sprains have come back to haunt me because people think that they sprain their ankle and they’re good, and they may feel fine. But there are movement restrictions that set in after an ankle sprain that you don’t realize as the layperson. That will trickle up to your knee, and it trickled up to my hip, my left hip. This was many years ago, and I could not get relief, and I realized when I became a physical therapist that my foot was playing into it. So, that’s much better now. I’ve torn my hamstring badly, and that was actually – I had a patient, and she was about to faint on me, she hadn’t eaten. And I went to pick her up and I felt my whole hamstring just go. So that’s for me, and sometimes it’s harder as a physical therapist to deal with your own injuries because we’re the ones that we don’t take care of ourselves as well as we take care of our patients!

15:53
Dr. Maya Novak:
I know that people here that are listening to this interview, not just physical therapists, not just the people that are injured, also doctors and nurses, I think that every person who is in the medical system and serving others is going to say the same. We are the worst patients.

16:16
Erica Meloe:
Mhm, we are. It’s true. I think the more you know, sometimes it’s good. The more you know, sometimes it’s bad! And for your own personal.

16:24
Dr. Maya Novak:
Yes. So, what do you then say to someone because it’s not that unusual that I hear someone say, you know what, my doctor says that I don’t need physical therapy, that I can just walk it off, for example? What would you say to a person like that? What should they do?

16:47
Erica Meloe:
Do you mean walk off like an injury?

16:50
Dr. Maya Novak:
Yes. Like, for example, a lot of people that find me, they have some sort of ankle injury because my story is out there, right.

16:58
Erica Meloe:
Right.

16:59
Dr. Maya Novak:
So, people find that. And I’ve heard so many stories that after not just sprained ankles, also ankle fractures, well, my doctor said that I don’t need physical therapy. That it’s going to be okay and I just have to walk a bit more, and it’s going to be good.

17:17
Erica Meloe:
Right. It often surprises me why doctors don’t refer often for physical therapy, the ones that have good experience with physio do. But you need physical therapy, and that for me, because we have – I’m in New York – most States in our country have what we call direct access. Which means that you can access a physical therapist without a doctor’s referral, at least in New York, for at least 10 visits or 30 days whichever comes quicker. And those are different from State to State, but many people who are suffering don’t know that you access a physical therapist without seeing a physician. Nothing against the physician, but sometimes it’s you have a wait a long time to get into see them and as a physio, you can quickly assess and see if they need emergent care. But it bothers me that they say, oh, you’re going to walk it off. No, because you need – number one, especially with a persistent injury, you need someone to listen to your story. Most physicians don’t have the time just because of the model they’re in. It’s very quick and I understand that. But you need someone, especially the persistent pain, and even the acute. You need someone to listen to you, and you need someone to understand your story. And that’s therapeutic in and of itself, let alone getting the actual physical assessment. But I don’t buy that that you can just walk it off or you can do that. I mean, it’s very, very rare that I see a patient that I just see for them for one visit. Like I can always help somebody to some degree, and I don’t think I would ever say to a patient oh, just walk it off until it feels better. That’s a cop-out, I think, in my view. I do think that if the person does not need “physical therapy” per se, physical therapy is not just physical. You’re dealing, and much more so now with our whole biopsychosocial model of care. We have the physical in our sort of designation, but it’s much, much more by biopsychosocial. You’re taking into account the whole person and that means looking, as we said, emotionally and cognitively. So, I do believe that some of the physicians don’t understand that, and they think to this day that all physical therapists do are going to give you exercises. That’s part of what we do. That is by far not anywhere near what we can do in totally. So, that’s the long answer to your question!

19:57
Dr. Maya Novak:
No, this is really good and really helpful because those who hear something like that, now they know actually why they need it. But let’s also talk about how do you actually then choose a physiotherapist because it might be that there is only – if you live in a really small town, for example, there might be only one physiotherapist.

20:19
Erica Meloe:
Right.

20:19
Dr. Maya Novak:
But how do you choose? Is it important when we are deciding which physiotherapist is the right one for me?

20:28
Erica Meloe:
Right. So, some people in the US, we have – my practice is – like I’m not contracted with an insurance company. So, a lot of people will go to see people who will take their insurance, and that will be the deciding factor for them. And I can speak for me in New York, a lot of high volume practices, we see a lot of patients tend to have that in-network model. I’m more of an out of network cash smaller boutique practice. And so I would say the most important question for me is – there’s many questions - but how long does the physical therapist spend with you? Okay. Is it 10 minutes of whatever they need to do and then you go to an unlicensed aid, and they watch you, which is a waste of your money or insurance company’s money. I mean, there are some really good aids, but you’re paying for your physical therapy treatment. And so my question would be is how long are the evaluations? They’re usually an hour in my office, sometimes longer depending on the person. And will I be with the physical therapist the entire time, and how long will that be? And also, will I see the same physical therapist every time? I have heard many stories where they bounced from therapist to therapist, and that’s not good for the therapist or the patient. You need to have continuity of care. You need to develop a trusting relationship with your therapist, and that only happens with continual face time with them.

22:06
Dr. Maya Novak:
Mhm.

22:07
Erica Meloe:
So, it’s really the time spent. For me, that would be the biggest question.

22:11
Dr. Maya Novak:
Yes. And I love these three questions that you just shared, and when I read them in your book I was like that’s amazing because yes, and you actually can treat physiotherapy services – you can interview them, right? You ask them upfront and then you decide. You don’t have to go there and that’s it.

22:32
Erica Meloe:
Exactly. So, I’ve had patients – people who have come to me have been many places. So, they often – and I would suggest this because I don’t think this is a bad idea – they actually want to speak to me on the phone before they come on because they want to make sure that we’re not like any – like not like the rest of them. Fifteen minutes on the phone is not a big deal to spend with a potential client, right. I’ve had that happen many times. Once I can get people on the phone, they generally come in. But I would advise patients who have been through many people, and they’ve had a lot of bad experiences or not so bad, asked if they could speak with the physical therapist and about it. And if the person answerphone the phone at the front says no you can’t, hang up and dial somebody else.

23:26
Dr. Maya Novak:
Amazing advice. So, what about if someone has a bad experience with a specific physiotherapist and/or they don’t see results or they are not experiencing really good progress, many times what happens is either, yes, they find another physiotherapist or perhaps they start searching for other medical professionals such as chiropractors and osteopaths and so on. So, what are your thoughts about that? Is it good just to perhaps find someone else in the medical field? Or is it still beneficial that a person tries out with another physiotherapist and if so, why?

24:10
Erica Meloe:
I personally think that they need to stay in our field. We are losing a lot of patients to other healthcare practitioners, like chiropractors, like massage therapists, personal trainers even. I do believe that there are some fantastic physical therapists out there, and would urge patients to stay within our field. If you are working with a physical therapist and you are not getting the results that you want, don’t just not make an appointment, just talk the physio. Say, I’ve got knee pain, the person’s knee’s being treated, and it’s not getting any better. I do believe that physical therapists will be open to the idea that maybe it could be the foot or the hip that’s driving your knee pain. Ask your physical therapist. Can you maybe look at my foot? I would say really important advice for any patient when they meet their physical therapist for the first time is to be upfront about any and all past medical history. Past injuries are very, very important, even if it was three years old. My ankle sprain was years ago, okay. It will come back to haunt you because you will adopt a movement pattern over time that will serve you well until you run out of options, or until you change your strategy. You could start a new running program. You could be in a different work environment, but those injuries matter. So, being honest with your physical therapist about those past medical injuries and past medical history will help. And if your therapist isn’t willing to do then I wouldn’t buy, but I would try to look for another physical therapist. I am biased towards the smaller practitioners, the boutique – we have a boutique practice. We have just me, and my business partner. Some of the more higher volume places, at least in my town, I don’t particularly – wouldn’t – there are some great physical therapists there, but I like the smaller experience, the more intimate and personalized experience. So, if as a patient, they’re not happy and they want to leave their current practice they’re in, look for a smaller practice and see if it’s any better. I would hate to see you lost to another profession.

26:34
Dr. Maya Novak:
And interview your future – yes.

26:38
Erica Meloe:
Yes, I would, definitely.

26:40
Dr. Maya Novak:
Now, can we talk a bit more about pain, and especially a very common question is how do you actually distinguish between good pain and bad pain? Is there such a thing and how do you actually then distinguish if something is actually good and helping you to progress or if something is actually hindering your progress?

27:04
Erica Meloe:
Right. There are some patients who are very focused on pain, who are extremely – and who have – I call them, as I mentioned, they’re non – they don’t cope – or they’re non-copers. And so, if you put them through, let’s say, for example, a movement like a squat, a really basic movement, and they’re right ankle hurts and they don’t want to even go near a squat ever again, and they’ve had the pain for 10 years. That pain is not bad. The tissue is healed. There’s nothing wrong with the tissue, the local joint, and the periphery. There’s nothing wrong, but their brain is perceiving that pain in the squat as a threat. So, you need to de-threaten – is that a word, de-threaten? To help the patient reduce their fear before they start to move? And I do that a lot with the mirror box therapy. There’s something called Graded Motor Imagery, developed by Lorimer Moseley and David Butler. They’re Australian physios and they’ve written Explain Pain and Explain Pain Supercharged. So, I use a mirror box a lot. I use their – they have a Recognize App for the Android and the iPhone to help desensitize some of that threat, that fear of pain. I also use – I have patients look at pictures or videos of people squatting. If, for example, it’s the squat that bothers them. I might watch somebody squat and assess your pain level pre and post. I mean, for example, there are people who look at somebody on a roller coaster and get dizzy. I’m one of those people, okay, seriously. So, you have to de-threaten. It’s almost like decreasing people’s fear of flying. You need to go through desensitization techniques. A mirror box is a great one. And so that pain, it’s not necessarily bad pain in that scenario, but they need to reduce their fear around it before they start to move and then that pain will decrease. The pain that you get after an acute injury, like my ankle sprain or my hamstring, that’s there for a reason. Your body has figured out that that’s threating to you. So, you need to ice it. You need to wrap it. You need to walk with a cane or whatever, wrap your thigh. That’s real pain. That’s an acute. That doesn’t mean go run a marathon. I’ve had patients run marathons with pelvic fractures, killing them. That’s not helpful, right, not helpful. But, they’ve got good coping mechanisms and they ran and they did fine. So, everybody’s very different. I think that as a physical therapist, you need to assess, and you can assess that very quickly in the first visit what type of a person they are and how they deal with pain. If you put your hands on somebody’s body and they’re jumping, well you know that that’s their personal space and you need to respect that. Like what I’ll do a lot with patients instead of moving their - let’s say it’s their right ankle that bothers them – if I’m sort of moving it all over the place, I will say that I’m going to do something on your left ankle, and then I do a series of movement. And then I say I’m going to do the same thing to your right. So, they know what to expect as opposed to – I had a patient go into a doctor’s office and the doctor literally took this guy’s hip, and moved it all around without asking him, and made him so much worse. And this just doesn’t happen with doctors, it happens with many people. They don’t – you need to ask permission to touch the person’s body at the end of the day. So, the difference between the pain is really, once again, the acute is the acute pain, and that’s – that is good pain in a way. I mean that’s pain that you need to pay attention to. But the persistent kind, you need to de-threaten that first. Don’t just push the patient through a squat if it hurts. That’s going to be helpful for nobody. Take a step back and maybe do a little weight shift. Do some desensitization and things like that.

31:05
Dr. Maya Novak:
So, what do you say then to a patient who says no pain, no gain. Can this be actually hindering progress? So, if I push it through, I’m going to get through it and I’m going to be fine. Or - we already talked about the nervous system and the excited nervous system – can that actually be creating something worse?

31:31
Erica Meloe:
It could do both. I mean there are people who I have treated who have been through a lot worse than persistent pain. They’ve had multiple life experiences where they’ve experienced things – and they’re the no pain, no gain, I’m going to pursue it. That, for me, that’s almost you need to be aware of people like that because they’ll be very aggressive in their program, and that’s not helpful. So, there’s a certain way that I would do exercise. I start out with very easy unloaded exercises or movements and then I have them move through specific phases of exercise. And there are people who are going to be like no, I’m going to go right to a jump squat and I’m going to jump up and down. That is not helpful at all, and that will cause other problems. I’ve had experience with this with patients. They come in with back pain, and then they start jumping before they’re supposed to, and then their foot hurts. You’re giving yourself another problem. I do think that those types of people, you will recognize those pretty quickly as well. But as a therapist, I absolutely – the best advice I give people at the first visit is what not to do. There’s some people who are really intelligent and they’ve been around the therapy world a lot. They’re like I’m doing this, this and this, what shouldn’t I do, and they tell you that the minute you see them. So, I end up cutting things out that they’re doing immediately and that solves a lot of their problems because they’re pushing themselves too hard. I think people need to take a step back in the short term. I always say, yes, you can go back to doing your running and your jumping, but right now you need to do these things in order for you to get back to that, and I think most people get that. There are a few who won’t do and I basically say, look, it’s just going to take you that much longer to get better. If you’re okay with that, then I’m good with that.

33:27
Dr. Maya Novak:
We'll continue in just a moment. I wanted to quickly jump in for two things. First, thank you for tuning in. And second, I’m sure you have at least one friend, colleague, or family member who would very much appreciate this episode. So share it with them and help us spread the word. Now let’s continue…

33:48
Dr. Maya Novak:
Yes. So, is there any general advice in regards to what not to do, especially, let’s say that we have a patient – a person that is listening right now, and perhaps that pain has been there for a year or two, or perhaps five years. Is there something that you could say that might not be a good thing to do right now, but there are also some things that are going to help them to slowly start moving forward? Do you know what I mean?

34:22
Erica Meloe:
Yes. The couple of things that I always make people are movements or positions that you adopt fairly frequently. So, for example, like I have had a patient who had chronic left arm pain, coldness, and numbness down her arm, and she sits like this all day, okay. That’s probably feeding into it. I recently taught a class here in New York, and I stood on my right leg the whole time. Like of course I did, I offloaded my left hip for years and I noticed that. And that will feed into - I do some spinning. So, when I’m on the spin bike, I notice I’m on the right side of the bike. If you’ve been suffering from persistent pain for a while, notice some movement patterns that you adopt. There are many women who, post-partum, it’s the child on the hip. That is a huge one that it could be that those are movement patterns that may be playing into your symptoms. It’s something you’re doing – short of trauma or surgery, it’s some strategy that we’ve been doing for so long, that’s served us really well, but over time we – as someone said to me, Erica, you’ve reached your buckle point. You’ve run out of options, and we all do. We’ve all have had pain at one point in our lives. The classic scenario is I’ve had low back pain for years, I get it every year. It goes away but this time it’s not going away. That is extremely common, and it’s movement patterning and that’s one thing that I would have people with persistent pain do. I also do think that reading a lot of David Butler and Lorimer Mosley’s work on Explain Pain is really helpful. There’s another great book, it’s an old one by Norman Doidge. It’s called The Brain That Changes Itself. It’s a great book and I think those are very, very helpful for people who’ve suffered for a long time. Especially the Explain Pain, they’ve got great illustrations and visuals. It really will help desensitize the system of it – a lot actually.

36:42
Dr. Maya Novak:
Yes. So, actually, we have to become conscious about what we are doing so that we are not just in automated mode, and doing what we have been doing for months or years, but actually start observing ourselves and what we are doing day in and day out.

37:00
Erica Meloe:
Right. Be more mindful. People are like, ‘oh when you mentioned that I sit like this’ – because sometimes I’ll see things. I’ll see shifts in their body. Like I’ll see shifts in their trunk, and I’ll see shifts in their center of mass. I’m like you’re on your right leg, ‘oh, I didn’t know that’. And then they think. The next visit they’ll come in, and they’re like ‘oh, I carried my child on here for five years’. Then when they understand that – knowledge is power. I think when people understand it could be something they’ve been doing that needs to be altered, that gives them hope. I’m not saying that that’s the main answer, but that’s part of it, I believe. I believe.

37:41
Dr. Maya Novak:
Wow. This is so very helpful. Now, in regards to pain, and we discussed before that when we are really distracted we do not perhaps notice pain.

37:57
Erica Meloe:
Right.

37:57
Dr. Maya Novak:
What are some of the things that people can do. How can they distract themselves or what do you suggest a person do so that they slowly start changing what is happening in their brain, in their nervous system, what are some of the things that you can share here?

38:17
Erica Meloe:
Everybody’s different. For example, if some wants to get on a treadmill and walk, I like music. Put music on. Do something that makes you feel happy or gives you joy. It could be listening to your – I’m all for mindful exercise, and I believe that, and I’ll talk about that in a second. But, for example, like an elliptical or any kind of routine movement, I do believe that thinking about something that’s joyful or musical really, really helps. Yes, you need to pay attention to where you’re walking, but you’d be very surprised – I mean you wouldn’t be – but I think that a lot of people would be. If you listen to some music that you love, you can walk much farther. I’m not saying have a chat with your best friend while you’re doing that, but some people do outside and they feel fine. But I also think that in terms of movements, what I have found – it’s been really interesting, I would say in the past year I’ve done a lot of work on imagery and healing. I see a lot of patients with multiple injuries, but a lot of times, the driver is in their trunk and their thorax, for example. It’s because of these shifts that we have. I’ll just leave it there because it’s hard to explain. But I’ll put my hands on their body and I will ask them to think of something joyful. I can feel changes in their body by doing that. I’ll have them say think of yourself on a beach. Any imagery that makes these people feel good. I’ll also imagine – because sometimes I’m looking for a specific thing. I’ll have them imagine balloons in your armpits because that gives you space in your thorax and your ribcage. It decompresses you. It’s like a down dog and child’s pose, but you’re actually thinking about it. And those are really helpful cues for people who are focused on is it going to hurt, is not going to hurt. Is it – am I shifted. Think of something joyful. Think about the movement in your armpits. I always tell patients to imagine you’re wearing the crown jewels. It’s amazing the difference in someone’s posture when you have them do that.

40:44
Dr. Maya Novak:
Mhm.

40:45
Erica Meloe:
Imagery is really important. Eric Franklin has a great book. I think it’s Dynamic Alignment Through Imagery. It’s a great book on just imagery and cuing. You can make them up, but those are really, I think, good things for the physical therapist who may be listening to give to their patients because cuing and thinking of things that are joyful really helps desensitize your nervous system.

41:16
Dr. Maya Novak:
And as well, this is very helpful to medical professionals, but also to patients or those who have problems. So, just imagining because our mind is amazing, and the amazing thing is that it doesn’t distinguish what is real and what is not. So, it’s good to relax yourself. Talking about mind and imagination, in your book there is an amazing quote, and I would love you to explain it and talk about a bit, and that is that imagining movement is almost as good as doing it. What does that mean?

41:52
Erica Meloe:
So, there’s been research out there that if you – for example, if a squat – I’ll keep using the squat. If a squat is threatening to somebody and they can’t squat, it really hurts them, it’s hurts their back, hurts their knees. I have my patients either, number one, imagine themselves doing a squat or look at somebody else doing the squat. Studies have shown that it activates the same part of your brain, the pre cerebral cortex, and the same way as if you were doing it. So, if you’re doing it, if you’re doing the squat or you’re imagining doing the squat, it has the same effect on your brain. The same part of your brain is being activated whether you’re imagining it or whether you’re doing it.

42:43
Dr. Maya Novak:
Mhm.

42:44
Erica Meloe:
So, I found that fascinating when I was writing my book. I was like do you mean that we can imagine it? So, for example, if you cannot – let’s say you tear your ACL. You can’t walk, you can’t straighten your knee, you need full extension after that, and you can’t get that. Imagine yourself getting that. Imagine yourself walking well without crutches. That really helps a lot. I mean I think that there’s a lot of science that needs to – there’s a lot of research out there on that now. But I do think that is much more prevalent now than it ever used to be back in the old days when everybody was doing ultrasound and electrical stimulation. I mean that – I don’t do any of that anymore, and I never really. But it’s more helpful taking your patient through some imagery instead of just slapping something on them, you know what I mean. So, I think that that’s very helpful.

43:36
Dr. Maya Novak:
It’s a visualization. I call this a healing visualization.

43:41
Erica Meloe:
Yes.

43:42
Dr. Maya Novak:
So, you’re actually working towards what you actually want to achieve and I love this explanation, what you just said because it activates exactly the same parts of your brain.

43:53
Erica Meloe:
Yes, and you need to do it often. So, if you just like look at something for five minutes, no. It has to be repetitive, repetitive, repetitive over – what, 21 days, I think that’s the habit. The time it takes to make it a habit. But when I have patients who are doing fairly well and I need to progress them to like a heavier load or impact, I ask them to do something that’s very easy for them multiple times, like 50 reps, because I need to train a new movement pattern that will take them to the next level. So, it’s not 10 reps while you’re watching TV.

44:29
Dr. Maya Novak:
Mhm.

44:30
Erica Meloe:
That, for me, is where the mindfulness part comes in. And you need to do volumes to establish new movement patterns. So, once the fear of pain is de-threatened, we’ve got past the helpful versus non-helpful pain, three sets of 10 reps is okay. But when you need to progress somebody, they need to do an exercise that’s easy for them. So, I often tell patients if you do – like I had a patient recently and she was like I love walking on the treadmill. That makes feel good. I’m like do it all day. Do it as much as you want because it makes you feel good emotionally, and it will make you feel good physically.

45:11
Dr. Maya Novak:
Yes. I would agree that back to basics is a lot of times a really good thing. So, really basic exercises.

45:21
Erica Meloe:
Yes.

45:21
Dr. Maya Novak:
So, it’s not something super complicated and something new, but it’s something that actually has been working for decades already, those basic exercises.

45:30
Erica Meloe:
Right. There is a time and place for doing very advanced work, and those are your high-level athletes, your fitness instructors. People who do this for a living or people who don’t who want to be able to do a handstand. There’s a progression to get somebody to do a handstand. I give a lot of basic little wall squats, holding onto the wall and just doing little squats, putting your heels on a half foam roller. They put their heels on the half foam roller and do squats. The foot is very common as a driver – a secondary, primary, tertiary driver in many people’s presentations. I have them do little squats. I take their feet out of the picture. They can squat much lower. They can do movement patterns without worrying about their feet. That’s a basic exercise. I just added a little nuance with the foam roller and the wall. People feel supported on the wall. They’re taking their feet out if it. If they’ve got tight calves or things like that or an old ankle fracture and they don’t have the mobility there. They can down a lot farther by taking that foot out. So, we can do the basic exercises, we just need to modify them just a little bit.

46:48
Dr. Maya Novak:
Yes. Fabulous. Now, we covered a lot. If you would have to choose just one thing, what is your number one advice that you would give someone who is injured and is recovering right now?

47:03
Erica Meloe:
Oh, that’s a good question, the number one advice. My advice would be – it’s easy for me to say this, but I would be open to other potential sources to your problem, and it may not be physical. So, it could be, but it could not be. I could be the combination of the two. So, that would be my advice. If people say I’ve had knee pain forever, I’m going to treat my knee and I’m not getting better. Okay, take that out of your head. Be open to the fact that maybe it’s something else or maybe it’s some cognitive or emotional barrier that you’re dealing that’s prohibiting you from moving forward. That would be my advice.

47:51
Dr. Maya Novak:
I love this advice. I love it because so many times it is not just the physical. This Summit and every speaker that I talk to, we go beyond just the physical because many times, yes, it can be. We talked about good pain, bad pain, chronic pain, acute pain, so it can be just the physical, but many times that’s not the only thing that is happening. So, I love this advice.

48:22
Erica Meloe:
Yes. It would be a huge barrier to someone’s recovery if they cannot get past their cognitive or emotional issues. It would be a major barrier. So, that needs to get addressed like from the get-go, I believe.

48:34
Dr. Maya Novak:
Yes. Now, if someone is listening right now, they have been in pain for years and years, and they are actually losing hope about anything actually changing in the future, what would you say to someone who is losing hope?

48:51
Erica Meloe:
I think the same advice actually. I do think that we need to be open. And yes, there’s always hope, and that’s easy for people to say. That’s advice I probably wouldn’t say, that’s not helpful. I do believe that we should be open to other sources. I think that we’ve all had something in our life where we’ve lost hope. And I do believe that writing down your thoughts, journaling, doing things like that is really helpful. And I do believe that thinking about maybe getting a multi-disciplinary team – a psychologist is a really important, or a therapist, or anybody – or a coach online or in-person is really helpful for working things out because it’s important to get somebody behind you and getting a support group. You can’t do this by yourself. No-one really can. We’ve had many athletes, high-profile athletes who have many injuries, and they have a team around them, and they went into deep depressions over injuries, and trust me, I’m sure they lose hope, but they come through it because they have a team. If you have a close relative you want to talk to. I think that’s really helpful to get some form of support. I do. I think that’s my advice.

50:25
Dr. Maya Novak:
Beautiful. Yes, there is a saying, I don’t know where it came from, but it takes a village to raise a child.

50:34
Erica Meloe:
Yes.

50:34
Dr. Maya Novak:
So, it’s the same with injuries. It’s not just I need just one person, just my doctor or just my physiotherapist or just whoever, but it’s actually taking care of every single aspect like you said.

50:48
Erica Meloe:
Yes, I think you deserve that as a human being. You deserve to have kindness and have people who are – you need a quarterback, you need people on your side and even if it’s one person. I think it’s important to have. It’s easy to say that we’ve got, you know, they’re athletes, they can have multiple people, but you just need one person, really, and who understands you, is kind. Kindness goes a long way in helping people, and I think we need to really be kind to ourselves and be kind to others. Getting the emotional support and even if it’s a phone call once a week, I think is really, really helpful.

51:37
Dr. Maya Novak:
Amazing advice. Erica, I have one last question that is a fun question, and definitely an out of the box question. That is, imagine that you are being injured right now and you know that it’s going to take you a while to get back on your feet so to say. And now, in this moment, you can choose one of two gifts or one of two options. Now, number one is that you go through everything and do everything in your power to heal in the best possible way, and then at the end, you are gifted with a gift of not being injured in your life anymore. Or number two is that you can go back in time, prevent the accident, prevent the injury, but then you are taking your chances and you don’t know what’s going to happen in the future. So, my question here is what do you choose, and why?

52:33
Erica Meloe:
I would choose the first one. I would go through the rehab, have the injury, and prevent future injuries. I mean that’s a no brainer for me. I mean I think you learn – there’s one thing having had as many injuries as I’ve had, you learn a lot about yourself when you suffer an injury, and you learn a lot about other people. That’s immeasurable. As a human being, I think we all have had many injuries, and who wouldn’t want to prevent future injuries? That’s why I would choose that, for the prevention aspect, but just because you really learn. You really realize what kind of a person you are when you suffer an injury. You do, whether that’s good or bad, but you grow and growth is always a good thing.

53:23
Dr. Maya Novak:
Oh, I love this. Erica, where can people find more about you and your work?

53:29
Erica Meloe:
So, my website is ericameloe.com. My book website is ericameloewhydoihurt.com. And I have a practice in New York, and our website, it’s currently being worked on, but it’s velocityphysiony.com. So, those are the three places, and social media, of course.

53:54
Dr. Maya Novak:
Fabulous. Erica, this was fantastic. Thank you so much for being here and for sharing your knowledge and helping people heal and go way beyond the physical aspects of pain and really recover from pain, chronic pain. Thank you.

54:11
Erica Meloe:
Thank you, Maya. I’ve loved it. Thank you.

54:15
Dr. Maya Novak:
This wraps up today’s Mindful Injury Recovery Talk with Erica Meloe. If you haven’t done it yet, subscribe to the podcast on whatever platform you’re using to tune in, and share it with your loved ones. As you know: sharing, yes, is caring. To access show notes, links, and transcript of today’s episode go to mayanovak.com/podcast. To learn more about The Mindful Injury Recovery Method visit my website mayanovak.com and find my book Heal Beyond Expectations on Amazon. Until next time – keep evolving, blooming, and healing.