Becoming Pain-Free: Tom McDevitt Of Athletico Physical Therapy On How to Alleviate Chronic Pain
An interview with Maria Angelova
Sleep: The more that we research sleep, the more we recognize how important it is in treating pain. There are several recommendations to consider between sleep duration and sleep hygiene, any, or all of which can help contribute to improved quality of sleep. I frequently inquire about sleep in my practice and educating on strategies to help enhance sleep performance.
So many people suffer from chronic pain. Often people believe that they have tried everything, and that there is no real hope for them to live pain-free. What are some things these individuals can do, to help reduce or even eliminate their pain? In this interview series, called “Becoming Pain-Free: How to Alleviate Chronic Pain” we are talking to medical professionals, pain management specialists and authors who can share their insights and strategies about how to alleviate chronic pain. As a part of this series we had the pleasure of interviewing Tom McDevitt.
Tom McDevitt PT, DPT, OCS, FAAOMPT is a Physical Therapist and Pain Therapy Program Manager, practicing at the Athletico Physical Therapy Niles/Northwest Chicago clinic since 2012. Tom specializes in treating spinal and other musculoskeletal conditions, with a keen focus on treating individuals with persistent pain. He takes great pride in helping educate his patients about pain and helping structure a personalized plan of care to achieve their goals. On top of his clinic duties, Tom is the Pain Therapy Program Manager for Athletico, dedicated to enhancing the quality of care directed towards the individual dealing with persistent pain.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” better. Can you share your “backstory” with us?
Absolutely. Really, my interest in physical therapy stems back to experiencing injuries playing sports in my youth and being fascinated with how we can heal ourselves through movement and exercise. This led me to pursue my degree in athletic training and my doctorate in physical therapy. As I began my career at Athletico Physical Therapy in 2012, I recognized that I had more of an interest in specializing in orthopedic care. This prompted me to enroll in both a residency and then fellowship program, which is where I was first exposed to some of the research being done to better understand the neurophysiology of pain. At this point everything changed for me, and I became invested in learning as much as I could learn about pain to better myself and my patients. That passion continues to this day as I not only treat people suffering from pain full time, but I also lead a specialized program for Athletico to help educate our clinicians on best practices to communicate pain to the people we work with.
Can you share the most interesting story that happened to you since you started your career? What were the main lessons or takeaways from that story?
One case comes to mind. A former colleague referred an individual to me who had been contemplating hip surgery. He had corrective hip surgery on his right hip and recently began experiencing pain in his left hip, prompting him to visit his surgeon. At that point he was recommended surgery or physical therapy, which is how he wound up coming to see me as he was hoping to avoid having surgery. At first, it was clear that he was fearful and limited in what he could do. This was a person who played competitive football and ran multiple marathons, and was now afraid to squat down to the floor to avoid complicating his hip pain. We spent the initial visit reviewing his symptoms, educating him on pain, and providing him motivational cues on how physical therapy can help treat his symptoms to ideally avoid surgery. He was very receptive to the plan and showed tremendous growth utilizing a balanced approach between hip mobilizations, strengthening, and pain neuroscience education. Fast forward a few weeks, about one month following completion of his plan of care, he emailed me to let me know he had signed up for a 10k race and that he was pain free with his exercise and training activities.
One lesson from this story is how much of an impact we can have on the people we work with by just listening to them and helping them better understand the symptoms they are experiencing. For example, he was most concerned about further injuring or complicating his hip pain and therefore avoided any activities that provoked this symptom. As we are more aware now, it is symptom behavior that is more relevant in the story and by structuring an education program to better understand this, he was able to gradually increase his hip mobility and strength to then tolerate weighted squats and eventually running.
It has been said that our mistakes can be our greatest teachers. Can you share a story about a mistake you made when you were first starting? Can you tell us what lesson you learned from that?
One story that I frequently share in a course I teach is one that most of us can relate to as we initially learn to communicate the neuroscience of pain, and it involves the statement: “The pain is in your head.”
Although the literature firmly indicates that pain is an output from the brain, the message needs to be carefully delivered to the person experiencing pain. I initially made this mistake of including this information early on in care in an effort to be transparent. Unfortunately, this led to some unnecessary confrontations and contributed to more challenging cases.
My greatest takeaway here was to defer to the nervous system as the culprit and direct attention to how longevity of symptoms contributes to increased sensitivity to physical and emotional stress.
When it comes to health and wellness, how is the work you are doing helping to make a bigger impact in the world?
The unfortunate reality is that we are living in a pain epidemic. Costs to treat chronic pain continue to climb and consistently exceed the cost of heart disease, cancer, and diabetes. Pain is misunderstood, and more likely to be treated with medication or surgery than something less invasive and less costly like physical therapy. I passionately believe if we invest our time to better understand pain, and reorganize our approach in healthcare to listen and align with our patients, we can more successfully treat pain and minimize the burden on our healthcare system. Truly, I feel so grateful to work for an organization such as Athletico because I am provided the utmost support in my role to help better prepare our clinicians across our network to better understand pain and optimally treat our patients. That is why in 2020 we invested our time to deliver material to each of our clinicians to expose them to pain neuroscience education and prepare them to deal with simple to complex patient populations. I am immensely proud of the direction we as a company, and profession, are going to help mitigate this healthcare burden.
Let’s jump to the main focus of this series. For the benefit of our readers, can you please tell us why you are an authority on the subject of chronic pain?
As I mentioned, I am the Program Manager for the Pain Therapy Program at Athletico. Within this program, I provide updates and content on relevant literature and lead courses to elevate our clinician’s ability to deliver key messages about pain to our consumers. Across our platform in 2020, we established a self-paced curriculum to expose each of our clinicians to key concepts of pain neuroscience education and help each of them establish themselves as a certified pain neuroscience educator. We believe that this initiative will help create more access for essential and optimal care for the individual dealing with pain.
Can you please share with us a few of the most common causes of chronic pain?
One of the most common causes of chronic pain relates to the fear avoidance cycle. Consider you experience an injury, like an ankle sprain walking in the park. You are affected by not being able to walk for a few days and as swelling reduces, you decide to try walking. You take a few steps and experience some increase in your symptoms of pain. You have a decision. Let’s say you believe something is still wrong, so you decide to stop walking and continue to rest. This behavior continues, notably beyond what the research would say is typical for healing time. So, each time you walk, you experience pain and decide to stop in fear of reinjury. This perpetually sensitizes this feedback loop and yields longer, more frequent pain experience, or in other words, chronic pain.
This is particularly common when it comes to lower back pain. Research has shown that each of us will experience low back pain at least once in our lifetime, and when it comes to the development of chronic lower back pain, a lot is placed on the decision you make after you experience pain. As I mentioned, if there is fear and/or avoidance associated with your back pain, the transition to chronic lower back pain is unfortunately very common. That’s where physical therapy can play an integral role in mitigating the development of chronic lower back pain. By accessing physical therapy early in this cycle, it becomes much more likely that you will be able to reduce the likelihood of developing chronic symptoms and safely returning to the active lifestyle you may have once feared was in jeopardy.
There are many different types of pain that people struggle with. Which specific form of pain would you like to focus on in this interview? Why that one?
Easily, the form of pain to focus on is chronic pain. We know that it consistently costs more to treat chronic pain compared to heart disease, cancer, or diabetes. Chronic pain is defined as pain lasting for three months or longer, which typically falls beyond the expected healing times of most of our body’s tissues. The challenge is twofold here.
One, most people don’t access healthcare early on. Most people abide by the wait and see approach and although this is not always a detrimental method to deal with pain, it can contribute to development of chronic pain especially if fear and avoidance are playing a role in your recovery. The recommendation is early access, especially to physical therapy, to help mitigate the risk for transitioning to chronic pain and reduce overall healthcare cost. Evidence supports early access to physical therapy as this can reduce the risk of money spent and potential need for surgical intervention.
Two, most people believe that chronic pain means an injury has not healed yet. It is well documented that the tissues in our body heal consistently between three to six months. Therefore, most of the pain experienced beyond normal tissue healing is associated with a heightened sensitivity to a stimulus and changes within our bodies’ own nervous system. The good news is research proves this is treatable and a combined effort of educating on pain and movement-based interventions can play a significant role in your recovery.
I believe the more we are aware of how we develop chronic pain, the better we can treat chronic pain as well as reduce the risk of developing chronic pain by providing necessary education and physical therapy.
Here is the main question of our interview. Can you share your top five “lifestyle tweaks” that you believe will help support people’s journey toward becoming pain-free? Please give an example or story for each.
1. Mindfulness: In a fast-paced world, rarely are we able to take the time to relax and breathe. Mindfulness plays a significant role in our ability to treat pain, mostly in its effect on the nervous system. In short, we have two parts to our nervous system. One being our fight and flight nervous system, which plays an important role in helping protect us and performing in stressful situations. As you may be aware, this system is highly active when we experience pain, and is particularly hard to shift out of when we experience chronic symptoms. This is where mindfulness can be particularly effective in treating pain. By taking the time to practice thoughtful and paced breathing, you can shift towards the other part of the nervous system, the rest and repair. Truly, mindfulness can help restore the necessary balance of your nervous system and more successfully treat your symptoms.
2. Exercise: This is physical therapy’s bread and butter. Many people associate exercise with being challenging to commit to a program and that it is hard to perform. The great news is that research supports as little as 10 minutes of walking per day to achieve an aerobic goal should contribute to helping better manage the pain experience. If you are concerned about beginning a program on your own, this is a terrific opportunity to seek out physical therapy. Most states now allow for direct access care, including Illinois where I work, in that you can call today and schedule an appointment for an assessment to start your exercise journey smartly and safely.
3. Diet: I often share with the people I work with that we only have one nervous system and when an aspect of it is inflamed, the other is likely to respond negatively as well. This comes into play often in our world as many foods we frequently eat can have a negative inflammatory response on our body. This is particularly detrimental when we already are dealing with chronic pain. So, I would recommend building a relationship with a local nutritionist and having conversations regarding diet with our clientele to help best manage the pain experience.
4. Sleep: The more that we research sleep, the more we recognize how important it is in treating pain. There are several recommendations to consider between sleep duration and sleep hygiene, any, or all of which can help contribute to improved quality of sleep. I frequently inquire about sleep in my practice and educating on strategies to help enhance sleep performance.
5. Achievable Goals: One important thing to guide and help create change, especially when trying to gain control over your pain, is to establish both short- and long-term goals. Throughout one’s journey with pain there have been sacrifices or changes to activity or lifestyle that have negatively affected them. Therefore, it is important to help create a plan that is personalized in efforts to recover excitement and tolerance to the activities one loves and enjoys.
If you could start a movement that would bring the most amount of wellness to the most amount of people, what would that be?
I think it would revolve around some organized walk-a-thon to promote awareness on how we can successfully treat pain with movement and exercise. With how connected everyone now is through social media, there are avenues to enhance connectivity and share knowledge on what physical therapy can offer in the management of pain.
What is the best way for our readers to further follow your work online?
You learn more about Athletico Physical Therapy and pain education at www.athletico.com or follow us on social media (Facebook, Twitter, Instagram, LinkedIn).
Thank you for these really excellent insights, and we greatly appreciate the time you spent with this. We wish you continued success.
About The Interviewer: Maria Angelova, MBA is a disruptor, author, motivational speaker, body-mind expert, Pilates teacher and founder and CEO of Rebellious Intl. As a disruptor, Maria is on a mission to change the face of the wellness industry by shifting the self-care mindset for consumers and providers alike. As a mind-body coach, Maria’s superpower is alignment which helps clients create a strong body and a calm mind so they can live a life of freedom, happiness and fulfillment. Prior to founding Rebellious Intl, Maria was a Finance Director and a professional with 17+ years of progressive corporate experience in the Telecommunications, Finance, and Insurance industries. Born in Bulgaria, Maria moved to the United States in 1992. She graduated summa cum laude from both Georgia State University (MBA, Finance) and the University of Georgia (BBA, Finance). Maria’s favorite job is being a mom. Maria enjoys learning, coaching, creating authentic connections, working out, Latin dancing, traveling, and spending time with her tribe. To contact Maria, email her at angelova@rebellious-intl.com. To schedule a free consultation, click here.
