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Summary
On episode 595 of 40+ Fitness, Coach Allan sits down with Dr. Tom Walters, a board certified orthopedic physical therapist who specializes in pain and movement disorders and is the founder of Rehab Science.
Tom’s argument, drawn from his book Rehab Science: How to Overcome Pain and Heal from Injury, is that pain is biopsychosocial, not purely mechanical. Beliefs, stress, sleep, and social isolation all shape how much pain a person feels, which is why two people with the same MRI findings can have completely different pain experiences.
The conversation covers the difference between pain and injury, the three types of pain, and the three-phase recovery framework (calm the system down, resolve impairments, rebuild capacity) that Tom uses to help people recover on their own or alongside a physical therapist.
Links
- https://rehabscience.com
- Episode 757 – Why Rest Won’t Fix Your Knee or Back Pain with Dr. Tom Walters
Key Takeaways
- Pain is biopsychosocial, not just mechanical. Older models treated pain like a broken car part, but research shows thoughts, beliefs, stress, sleep, inflammation, and social isolation all shape how much pain a person feels, independent of actual tissue damage.
- Pain and injury are not the same thing. MRI studies on people with zero symptoms routinely find disc herniations, meniscus tears, labral tears, and arthritis in roughly half the population. You can have significant findings with no pain, and real pain with nothing visible on a scan.
- There are three types of pain, and treatment should match the type. Nociceptive pain is mechanical and localized, like a sprained ankle. Neuropathic pain involves the nervous system itself and often radiates, like sciatica. Persistent (chronic) pain has been present for months or years and stops accurately reflecting what’s happening in the tissue.
- Recovery follows three phases, and most people stop after the first. Phase one calms pain and sensitivity down. Phase two resolves impairments like lost mobility or strength. Phase three rebuilds capacity through resistance training. Tom notes people often quit once pain subsides, skipping the phases that actually prevent re-injury.
- Movement beats immobilization for most soft tissue injuries. Research now points away from prolonged rest, since joints stiffen and range of motion is harder to regain the longer they stay immobilized. Early, appropriate mobility work speeds recovery instead of risking it.
- The cross-transfer effect makes training the healthy side worthwhile. Research shows that continuing to train an uninjured limb can help preserve strength on the injured side, even without directly working it.
- Fear of re-injury can be more limiting than the injury itself. Fear and anxiety about pain can actually amplify the pain response, since the brain interprets that fear as a signal of ongoing danger and ramps up its protective output.
- Sleep is the foundation of physical recovery. Musculoskeletal tissue remodels during sleep, so Tom places sleep ahead of any specific rehab exercise or intervention when it comes to healing from pain or injury.
- Dr. Tom Walters’s three strategies to get and stay well: prioritize sleep as the foundation for tissue recovery, keep moving through exercise even when modified around an injury, and manage the psychology of stress, fear, and anxiety that surrounds pain.
“Movement and exercise are one of the most powerful modulators of pain.”
Dr. Tom Walters
Another Episode You May Enjoy
Episode 615 – Pain-free knees and shoulders with Dr. Alan Reznik
Episode Notes
Podcast: 40+ Fitness
Episode: 595
Published: 2023-06-20
Host: Allan Misner (aka Coach Allan), author of The Wellness Roadmap
Guest(s): Dr. Tom Walters, a board certified orthopedic physical therapist who specializes in the treatment of pain and movement disorders, Rehab Science
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