Welcome to Episode #1 of the Healing Pain Podcast with Shelly Prosko!
Pain is one of the most prevalent, costly, and disabling conditions yet it often remains inadequately treated. With so many people suffering from persistent pain and so few resources to address this public health problem, the mission of this podcast is to build awareness about the issue and provide a free resource to the public, practitioners and policymakers.
Today we are joined by Shelly Prosko, Physical Therapist, Professional Yoga Therapist & Pilates Instructor.
In This Healing Pain Podcast You Will Learn:
- Why yoga is about more than flexibility, poses and asanas.
- How to integrate physical therapy and yoga into clinical practice.
- How yoga can help people suffering from persistent pain.
- The types and styles of yoga that are better than others for people in pain, and those to avoid.
- Tips and recommendations for people in pain that are interested in starting a yoga practice.
- The latest science on how the brain changes with chronic pain.
As a Physical Therapist and Professional Yoga Therapist, Shelly is dedicated to bridging the gap between yoga and modern healthcare philosophies and believes this integration is highly effective in creating and sustaining optimal health.
She received her Physical Therapy degree at the University of Saskatchewan, Canada, her Medical Therapeutic Yoga training at Professional Yoga Therapy Institute in North Carolina, her Pilates certification at ProHealth and Fitness Institute in Maryland, and her Pain Care Yoga Certification through Life is Now.
Shelly has been integrating yoga into her physical therapy treatments since 1998, addressing a wide variety of conditions with a special focus on helping people suffering from persistent pain and pelvic health issues.
Currently, she travels internationally offering specialty PhysioYoga Therapy workshops, lectures at medical college programs, instructs at numerous yoga therapy schools and presents at international conferences. She also actively promotes the integration of medical therapeutic yoga into our current healthcare system. She is an adjunct faculty member at the Professional Yoga Therapy Institute.
Shelly is dedicated to inspiring, empowering and educating health professionals, yoga teachers, therapists, students and people in pain about ways yoga can be used safely and effectively to address a variety of health issues and improve quality of life.
Please visit www.physioyoga.ca for more information about Shelly Prosko, PT, PYT and workshops.
Welcome to the first ever Healing Pain podcast. I am your host, Dr. Joe Tatta. I’m a Doctor of physical therapy and a nutritionist and it’s my mission with this podcast to begin a new conversation around the way chronic pain is treated. Not only in the country that I live in, which is the United States of America, but also across the entire globe as the chronic pain epidemic is a global epidemic. Now in the podcast you will hear from experts from the field of medicine, physical therapy, nutrition, crystal development, exercise, psychology. There are many ways into the chronic pain problem and with that there are many ways out of it. Those will be the topics that my guests will be talking about. Each week I’m going to deliver you free content, so if you are someone that struggles with chronic pain this is a place where you can come back each week to receive free information about ways to reverse your chronic pain.
If you are a clinician, such as a doctor or a physical therapist, a physician, a nutritionist, anyone who works with patients who have chronic pain, this is also a place where you can come and get the latest information. If you know someone who would like to speak on my podcast, please go to my website, and they can reach me there at www.drjoetatta.com. As well, you can sign up for my email list. I’ll send you weekly updates when the podcast goes live. I want to jump right into today’s guest. She’s been an incredible first guest. Her name is Shelly Prosko. She is a physical therapist, as well as a yoga instructor. We talk about everything, from how physical therapy can help your pain to how yoga works, to how the brain science and how learning about the brain interacts with your pain can help your healing. Without further a due, please help me welcome Shelly Prosko to the first ever Healing pain podcast, and I look forward to seeing you on future podcasts each week. Hi Shelly Prosko, welcome to the Healing Pain podcast, it’s great to have you here today.
Thank you, I’m so happy to be here. It’s an honor.
I’ve been waiting to have you on because we’re going to talk about physical therapy today, we’re going to talk about yoga, some other integrated strategies. But first, tell me about your physical therapy experience and background because you have been a physical therapist for a number of years. Tell me a little about the setting you work in and how that has influenced your practice currently.
Well, I actually started in long term care back in 1998. Lasted there for about a year and then I wanted to get into the outpatient orthopedic setting. I did that for probably about, I guess it worked out to 13 years or so. Within that time I just incorporated my yoga into my physical therapy practice and seeing all sorts of different special populations. Then I would say the last six to eight years, I’ve been focusing more on the persistent pain population and public health. Then the last four years, I actually left the formal outpatient orthopedic setting and then I just started something on my own, which the physio-yoga. The setting that I’m in now, I actually rent out a yoga studio and I see my clients at the yoga studio. Then some times when I travel I may go to their homes.
Talk to me a little bit, first about how the transition was for someone … Being a physical therapist so entrenched and kind of private practice. How was it to slowly integrate the yoga into your practice and what was the reaction of some of your peers let’s say?
That’s such a popular question. It was so organic. It was slow. It wasn’t like I just started doing it one day. Pretty much right off the bat in ’98 in long-term care, I started integrating yoga because the yoga came first. I started practicing yoga in the early ’90s and teaching. I just started doing things like balance groups for the residents, became yoga classes. Then in the private practice I just started using different yoga poses in my sessions. My colleagues, people were actually very supportive, they thought it was neat what I was doing. Then once I took formal training of medical therapeutic yoga, then I started to, “Okay I want to get a little more serious here because it’s not just about the physical posses.” It’s breathing, and meditation. Then I started to change the setting in the private practice. We have the curtains, we have the cubicles and I would move the tables and draw the curtains and go into there. But all the places where I worked, my colleagues were really supportive. They loved what I did. We would cross-refer.
They would give me, especially some of the complex clients, because of the bio, psycho, social, spiritual approach that I was able to use. The transition was, I will say, it was challenging in that the environment just isn’t supportive as far as the logistics. Time, lighting, quietness, things like that. As far moral support from my peers and co-workers and colleagues. The people, they loved what I was doing.
That’s awesome because physical therapy can be, at times it can be a little strict as far as time sessions. In the United States of America there are certain billing codes and things like that. It’s great that you’ve had such a wonderful transition and have bene able to move that into your practice very fluidly.
Yeah. Like I said, I had the moral support and everyone loved what I was doing, but that’s why I did have to leave that setting, was because of the time constraints and third party payers and billing. That is why I went into cash based. Just on my own. Those were the challenges for sure.
Awesome. So this podcast is dedicated to help people solve chronic pain and turn their chronic pain around. Start to talk to me about how yoga can help someone who has chronic pain. When we say chronic, we’re talking about pain really more than three of six months long.
Yoga, I will just say that it’s not necessarily what our common culture thinks it is, which is a lot of the yoga poses and movement. I mean that’s part of it, but yoga is a system of health. It’s a life science. Yoga really looks at all of our layers, the body, the mind, the breath, energy, spirit and it brings it all together. We use different breathing techniques. Yes different movement is included in that, mindful movement. Also, different meditation or mindfulness methods and yoga philosophy. It can work. Basically, yoga really works on all of the layers of the person. Research does show that breathing, different breathing methods, can help persistent chronic pain. Research also shows that movement can help persistent pain. We know that, in different exercise methods and also that meditation now. We’ve got more and more research out there that’s showing that mindfulness and meditation can help. Yoga has all three. It can really do a great job at that. There’s more and more research too now that’s showing that yoga helps. I would say by looking at all of the layers of the person, that yoga can really help with persistent pain.
When you talk about all the layers of a person, it’s very similar to what’s going on in the pain movement science right now, which is moving towards a bio-psycho-social aspect versus bio-medical aspect, which we’ve had for many years.
Exactly. When I do a lot with my presentations on yoga, I parallel the bio-psycho-social, I put in spiritual now in there like some other people do. The bio-psycho-social-spiritual approach. It parallels to the yoga pentia mia cotia model. The pentia mia cotia model is exactly what you were just saying. It’s the bio, the physical, the energetic, the spiritual, the mental, the emotional. We really call them koshas or layers. We look at each one of those layers and in our medical world, thank goodness, we’re starting to use this bio-psycho-social-spiritual model. But I have to say that we know about it and especially as physical therapists, we can asses cognitive function and mental and emotional. But then, what kind of tools do we have? That’s what I love about yoga. It’s really given me more tools in my tool kit to help that bio-psycho-social-spiritual part.
I love this conversation because my first thought is, how do people feel when they initially are told about this bio-psycho-social aspect and how it relates to pain because people in chronic pain have been through a number of MRIs, X-Rays, blood tests for autoimmune disease, you name it. People have looked for things. We’re now starting to see that pain is really an experience and what are all the pieces of that experience. When you start talking to them about this bio-psycho-social approach and how yoga can influence that and affect that, what’s their initial reaction to it? Is it one that is positive, is it disbelief, are they not sure?
In my experience in the last 15 years, I’ve had people … Usually I have kleenex near by, because they breakdown and they feel like this weight has lifted off their shoulders, like someone understands. I get hugs. I have never, to this day, had anyone say to me, “No, no, I don’t believe it.” Instead it’s the opposite. It’s very positive and it’s, “Oh I get it,” And, “I get it.” Of course I bring in pain science education. As we know, for the listeners that maybe don’t know, pain science education has been shown to be very important in helping people manage their pain and reduce pain. I bring that into the session. That helps too. Not just talking about ancient yoga wisdom, but trying to bring in the science.
Let’s dive into the yoga piece a little bit more. Let’s talk about meditation first and how that helps people with chronic pain. Because there is a number of articles and research PubMed about how it helps dampen the nervous system.
Well there’s a lot of different changes that happen in the brain with persistent pain and those changes are very similar to what happens when you meditate, as far as being the opposite effects. Areas for example, and I don’t know how much in detail we want to talk about the specific areas of the brain but, that areas in the brain that are responsible for cognitive functioning, higher executive functioning for self regulation, emotional regulation. One thing that I find really interesting is the insular cortex. That are of the brain is so fascinating and with different meditative practices, especially the interoceptive awareness practices, what’s been shown is that there’s more information going into the insular cortex. Or the insular cortex may be just paying more attention to it, I’m not quite sure yet. Basically the insular cortex has been shown to increase cortical thickness of the gray matter, and that area does lots of things but it’s really important for emotional awareness. If you’re emotional awareness is heightened then you can better regulate your emotions.
Meditation, other changes it also has been shown to increase the cortical thickness of the gray matter in the hippocampus that helps with memory and learning. That could even help with the pain science education part, help them understand that more. Then the hippocampus helps to regulate the amygdala. So we know the amygdala in the brain is that part, that emotional reactivity and that’s the part of the brain that really catastrophises. That’s significant with people with persistent pain. That’s a significant change that can happen. Meditation basically …. There’s just so much. Just thinking how specific we want to get here. There’s also changes that happen even with decreasing inflammatory markers, improving immune function and increasing sleep. We all know how important sleep is as well. I don’t know if that’s enough, we could probably go on and on there but-
No, I think it’s awesome. You’ve mentioned multiple parts of the brain so far and I think to a lot of people who’ve had chronic pain for a long time, if they’re new to hearing some of this information, they’re really saying to themselves, “What is my brain have to do with my back pain or my chronic neck pain or my chronic knee pain?” Can you explain why learning a little bit about the science and why the brain is so important to people’s chronic pain and why, even further, why physical therapists are really incorporating that into their practice?
The brain is super important because our pain experience is 100% an output of the brain. I’m sure people have heard, “Pain is all in your brain.” We say that but, what we’re really saying is that it’s an output of the brain. It’s real, it’s in your body, you feel it but it’s an output. You have the signals that come from the outside world, the different sensory input. It goes into the spinal cord, the messages go up. They’re danger signals. There’s no such thing as pain signals, it’s just a level of danger. Over time, if you’re experiencing persistent pain, all of a sudden now what can happen is, the brain can start to interpret these messages that reaches it as threat or danger. The output is, your pain experience which yes, is a physical sensation of pain but the output of the brain has also things like, your breathing the changes or you go into these protective postures. You start to move differently, your thoughts and your emotions start to change like fear and anxiety. Basically, your whole system goes on high-alert and becomes hypervigilant. Your body wants to protect you.
Awesome. Obviously with pain and painful syndromes, there’s always some kind of movement component to it. Muscles are tight, muscles are weak but the new concept you’re introducing is one of how the brain is involved in the output of that pain, basically.
Yeah and I will say one more thing, when all that information goes up to the brain from the periphery from the tissues, from the outside world and it goes up. The brain has to make the [story 00:15:35] of it all. There’s 200 to 500 different areas of the brain, that have to make sense of all this information, then output is your pain experience. What you were just mentioning there as far as movement was concerned, how you move and what if you’re going to get into that protective response or let’s say you lift your arm, if you always do I this one way in this protective motion, that’s really the only option that your brain has. Back to the changes that happened in the brain. There’s also changes in the cerebellum, which is the area of the brain that does help with that refined, sophisticated, nice, smooth motion and movement patterns. It’s very very complex but again, that’s why I love … I think you had asked earlier I maybe didn’t address it, how physical therapists can do such a good job here because we’re movement specialists. We have that pain science education as well.
Awesome. Great. I love the brain science of it, I think it’s really important. Let’s say a patient now or a person now in the world who has chronic pain, they’re thinking to themselves, “Well, it sounds like yoga may be beneficial for me, I haven’t tried that yet. I’ve seen yoga studios on the corner, I’ve seen yoga classes in the gym, my local physical therapist has yoga.” How do I go about finding the best yoga place that might suit the needs of someone with chronic pain?
The first thing I would suggest is, if you can find your local physical therapist, that would be great, to help them help you. Just popping into a yoga studio may not necessarily be the best idea. Not because the teachers aren’t good or anything like that. It’s just, you need to know what’s safe for you. If we’re talking about the whole nervous system, you could have the most gentle, calm, we call it, restorative yoga where you’re supported and the teacher is fabulous. But if your nervous still thinks that there’s some sort of threat, the output isn’t going to change. The first thing I would say is, do find a physical therapist to help you with that pain science part and hopefully, you could find a physical therapist in your area that also does yoga. There’s more and more and more of them so we can talk at the end. I can help people figure out where to find that in their area.
If that’s not an option, I would suggest teaming up with your physical therapist who knows yoga teachers in the area and studios and specific classes that maybe, they may have a yoga for gentle pain or gentle yoga of pain class. That’s what I would do. The other thing is, if you just really want to start and you’re thinking … Whatever your obstacles may be and you can’t find that in your area or where you are, there is a lot of online options. Although I wouldn’t necessarily recommend just start moving right away and finding yoga classes, there some relatively safe options I would say for breathing, awareness practices and body awareness and body scans and things like that. I can give you more resources there but, I would start there because the first step to change your pain is awareness. That’s yoga. Remember, yoga isn’t always the movement. You could start with some of those awareness practices and breathing practices. Like I said you have your physical therapist help you find an appropriate yoga teacher and they can work together or a yoga class.
I think it’s awesome. Basically what you’re saying is, even if you find a gentle yoga class and you started and let’s say you had pain, don’t be alarmed, you may just need to get together with your physical therapist and maybe do some exercises first and get some education first and then try that yoga class again.
Exactly. I’ve seen people suffering from chronic neck persistent pain. I’ve seen people that do not do well with the very calm, restorative practices. It increases their fear and anxiety so then that input to the nervous system is the same, so the output is going to be the same. They did better with actually the more movement ones and the more power focused yoga believe it or not. You haven’t asked this yet but I think it’s important to mention, finding your set points. You can’t stay too far below the pain or you’ll never change the nervous system but you also can’t just ramp passed it because your nervous system will get angry at you because you’re not listening, and then it’ll turn the volume up even more. That’s where your physical therapist needs to help you to know, what’s too much pain.
It’s a really good point. Even if someone with chronic pain starts the most gentle, most basic class out there, they still might have pain.
However, that might be okay, as long as they are below the radar of their brain’s really hypersensitive danger signal.
It’s a complicated topic, you and I can obviously talk about it, but to someone listening who’s had chronic pain, just realize that, pain doesn’t always mean to stop basically. A lot of times you can work with just a little bit of pain, a little bit more each day and you’ll find that it starts to go away, is that right?
It’s right, exactly. The guide lines that Neil Pearson, you’ve had him on your summit last year. He’s open to sharing his guidelines that I teach and use. I would tell people with pain listening, it doesn’t matter if you’re doing yoga or whatever exercise or activity you’re doing. First thing, when you feel that edge of pain, when you start to feel it, ask yourself, “Do I feel safe? Am I going to pay for it later?” If you can trust that, “Yeah, I feel safe. I don’t think I’m going to pay for it later.” Then continue on slowly, mindfully, not recklessly an keep your breath calm, your body tension low and monitor your pain. This is where the yoga comes in, how to keep your breath calm and how do you keep your muscle tension low. That’s where some of the yoga practices can help.
Like I said, even online, if there’s some breath awareness calming practices and things to keep your body tension low, then you can apply that to even your everyday activities or to when you start to go for a walk or exercise or if your physical therapist has given you some exercises you can even apply that, those guidelines to those exercises.
Awesome. Can you talk to me a bit about breathing and breath? Because people with chronic pain often have shallow breathing, they have uncoordinated breathing. How does yoga address that and is there is anything someone could implicate, that can work into their life today let’s say?
When you have persistent pain for a long time, like I said, the breath typically changes because it’s meant to protect you. Typically what happens is you hold your breath, when you don’t realize it. Especially when you’re trying to do a movement that hurts or you start to breath really shallow and fast because the system is in a fear-fright-flight mode. Some of the breath awareness practices that you can do is, first of all just being aware. Well there’s two things, there’s breath awareness and then there’s breath control. The breath awareness practice is just watching and observing. You can take a moment to see how the breath is moving through your body. You’re not trying to change anything, you’re just observing. You can get into a comfortable position of course, that’s number one, but see how the breath is moving in your body, notice things like the texture of it, if it’s rigid or bumpy. Is it smooth? The rate if it, pace of it, the length of your inhale and exhale. Is there a gap between your inhale and exhale or is it one smooth motion?
The temperature of the breath as it enters and exits the nostrils. You can just take a minute or two even, anywhere that you are and just notice, how does that feel as it goes in and out? Are you breathing more through one side of the nostril or the other? Just really watching and observing and being aware and then the breath control practice, which is actually a skill by the way. We’re using this as something you have to do everyday. Again it could be just a couple minutes. I’ll give you an example of one practice that you could do is, just imagine that you’re breathing in through the right nostril, and then out through the left. Then back in through the same side on the left and then out through the right. It’s called alternate nostril breathing in yoga we call it Nadi Shodhana. It’s just a simple breath control practice. There’s lots more, I’ll probably stop there unless you want me to share another one but, I hope that helps.
Awesome. That’s great because someone can do that right now while they’re watching this. They can do it at their desk at work, they can do it at home.
The alternate nostril one I love. Another one the belly breath, just watching your belly, not pushing it out, but just watching it go in and out. Actually I do want to share this one, if I can real quick, because most of my patients love it and it’s one of my favorites, I do this every day. You pretend that the breath is just going up through the top part of the nasal passageway, right, all the way up. You can do that three times. You just pretend, the breath, you visualize it, just touching the top part three times, in and out and then you pretend that it’s the bottom. You visualize and imagine the breath just going through the bottom of the nasal passageway and then the inside, at the nasal septum, then the outside. You do three of each and then when your finished that, you imagine the breath is now not touching the walls of the nasal passageway at all. It goes straight through the center and all the way back in. Yeah, simple.
Simple, which I love because a lot of times in a yoga class they’ll tell you, observe you’re breath going in and out. I think a lot of people have a hard time observing their breath going from their nose, down their trachea to the their lungs and back out. It’s a big leap for people, if they’re not thinking about their breath on a normal basis.
With your patients, I bet this happens to you. What do they say when as soon as you tell someone to, “Okay, let’s observe the breath.” They start breathing, purposefully and more. That’s what I always see, people start to increase effort. It’s guiding them to let go, get out of your own way, see if you can watch in observance and sometimes they don’t get that right away. Sometimes they-
Or they say, “If I’m not breathing correctly, wouldn’t I be dead already? Or I wouldn’t be alive.” Which is, I tell people all the time, “When you breathe you get fresh oxygen into your lungs which permeates all of your cells. It’s healing basically. With really shallow breathing, you don’t get the same kind of oxygen into your body and oxygen is your number one nutrient that you need for your survival, even for pain.”
Yeah, and also that way you breath can increase muscle tension, right? There’s the physiological changes like you were talking about and then there’s also the muscle changes. The sympathetic nervous system and I tell my patients that a lot. Even though, yeah you may be breathing and you’re alive and everything, it’s good. But if you’re breathing with these neck muscles up here, that can increase the input into your sympathetic nervous system or that fear-fright-flight system which can feed into the pain cycle. If you breath hold as well, that changes your nervous system to then hyperventilate after that. Then when you breathe fast and shallow and too much, then you’re carbon dioxide goes down. You’re blowing off too much carbon dioxide and then a really neat thing happens there, the Bohr effect. Did you know that the hemoglobin actually decreases the release of oxygen into the tissues because that carbon dioxide is too low. We could go on and on about how an abnormal breath pattern can change you’re pain but …
Yeah. My question for you is, I’m sure there are people watching this podcast right now that have chronic back pain or chronic neck pain or chronic joint pain. They’re saying, “You know, I’m going to I’ve this a try. There are two physical therapists talking to me, they sound like they’re integrating everything from breathing, to movement to the brain, which is really interesting.” What do you prescribe for them as far as starting? How many times a week? How many minutes?
As far as the research goes, we don’t really have anything solid but, we do know to change the nervous system, okay? To make these changes, that a daily practice is necessary and regular, very very regular and consistent over about four to six weeks. Some of the literature says like for motor learning, such as change or different movement patterns, 30 to 60 minutes. What I would suggest, for someone listening is, if you can, try start at at least three times a day, five times if you can but three times a day at least, for even just five minutes. Three to five times a day for five minutes, you can set a timer, do some sort of breath awareness or breath control practice or a body scan meditation. Like I said, I can share some online resources. It does have to be daily to really get the consistent changes. Again you have to work with your therapist because if you’re having a flair up day, when you come to the movement practice, that might change, what your movement is it might change, it might look different.
Right. In that five minutes daily, a couple times a day, it may be a couple minutes focusing on breathing and then maybe one or two postures.
Yeah. What I meant more there, the three to five times a day. I was talking about more the awareness and meditation practices. What I would recommend for people as a, and again, I’m taking this from Neil Pearson’s work, which worked fantastic with my patients and it’s that, daily plan. Every morning you wake up, you have three sheets of paper that you have written down activities that help you … I don’t want to say distract you but, your respite activities. Activities that bring you joy, that are fun. It could be talking on the phone with someone. Things that are … Art, doing some art work, listening to music. Then you have another sheet of paper that, that would be your calming activities. It could be these breath awareness practices we’ve been talking about, breath control, those kinds of things. The calming ones. The third one is that that’s the challenging activities. The movement and the exercise that have been prescribed for you or that you want to try. Every morning you have to figure out how you’re feeling, how many of each you can do.
That’s why I was hesitant just to blurt out a dosage because it depends. If you’re having a really good day, you may say, “I want to do three from this challenging exercise or the challenging activities.” One can be going for a 20 minute walk, the other one do my three yoga postures or my three yoga movements and three, I want to cook a nice supper. I can do two of the calming activities and one of the respite ones. If you’re having a flair up day, that might switch. I hope I didn’t confuse people but I think, number one would be, the five times a day dosage that I gave you. That would be just the awareness practices. I wouldn’t go do movement or posture five times a day. I would just do the observation and the breath awareness.
Okay great. Some great take-homes there.
Shelly, I really want to thank you for being on the first podcast, for the first Healing Pain podcast. You’ve given us tons of great strategies and input. Thank you so much.
I’m just so honored and grateful that you had the time to fit me in. Thank you Joe.
Can you tell us how people can learn more about you, both from the physical therapy side as well as the yoga side? Your website. How can we follow you?
Yeah. I have my website is physioyoga.ca. I’m in Canada. Everything’s on there. I have a YouTube channel. I have several videos there and some of them are the meditation practices and movement. You can follow there. I’m on social media as Prosko yoga but you can find the links on my website to facebook, Twitter. That would probably be the best. Signing up for my newsletter is a good way to keep up to date because then you get it about once a month. You get any kind of new videos I have out or articles.
Awesome. You and Neil did a yoga program together, is that right?
Yeah, Neil Pearson, also I highly recommend checking out lifeisnow.ca. He’s a phenomenal physical therapist, yoga therapist, assistant professor at a university. We have the Overcome Pain with Gentle Yoga videos. There are seven different sessions and the first five to 10 minutes is all the awareness. Breathing awareness and body awareness practices. I’m going to say, I’m not going to be shy about this, they’re beautiful. They’re set in Salt Spring island, the music and everything. We’re getting a lot of great feed back from people. Then the remaining 30 minutes is the movement practices. I’m doing the regular standing up, sitting down, changing positions on the mat. The whole thing, in all seven practices, he’s in his chair. You have lots of options to follow. If you can’t follow me, you can follow Neil in the chair.
Awesome. Excellent. Shelly I want to thank you so much for being on the podcast today and for giving people’s chronic pain hope and a lot of strategies. They can always get there. There is always a path to healing someone’s pain. Thanks for being here. If you have any questions for me, you can find me at my website, drjoetatta.com or you can send me a question on Facebook at Joe Tatta, dptccn. We will see you next week on the Healing Pain podcast.
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