Overcoming Pain and Rehab Science with Dr. Tom Walters
Dr. Tom Walters, a board-certified orthopedic physical therapist and founder of Rehab Science, challenges the long-held belief that pain always indicates tissue damage. He argues that modern pain science reveals pain as a complex output of the brain, shaped by biological, psychological, and social factors—what he calls the biopsychosocial model. This shift means that even when imaging shows no structural injury, pain is still real and valid. Walters warns that overusing pain science education can backfire, making patients feel dismissed or confused, especially if they’re already struggling with trust or fear. Instead, he advocates for a patient-centered approach that prioritizes building trust, using graded exposure to desensitize the nervous system, and emphasizing movement variability over rigid form. His new book series breaks down rehab into three intuitive phases—calming inflammation, rebuilding mobility and motor control, and progressively building strength—tailored to common injuries like low back and shoulder pain. Crucially, he promotes the idea that 'there are no bad movements'—any exercise can be reintroduced with proper progression, not fearmongering. For trainers and coaches, this means focusing on education, confidence-building, and long-term self-efficacy over quick fixes or dependency on professionals. The episode underscores a paradigm shift in rehab: pain isn’t a signal of damage but a protective response that can be retrained.
Pain is an output of the brain, not always a sign of tissue damage—this is why imaging often shows no injury despite severe pain.
Overusing pain science education can backfire, making patients feel dismissed; instead, focus on building trust and validating their experience.
Use graded exposure: gradually reintroduce feared movements (like bending or deadlifting) in small, manageable steps to desensitize the nervous system.
The three-phase rehab model—calm inflammation, rebuild mobility and motor control, then build strength—provides a clear, intuitive framework for recovery.
There are no 'bad movements'; any exercise can be reintroduced with proper progression, not fear or restriction.
…and 3 more takeaways available in PodZeus
The Danger of Over-Explaining Pain Science
Dr. Walters warns that while modern pain science shows pain is a brain output, simply telling patients this can make them feel dismissed or like their pain is 'all in their head,' especially when they're already struggling with trust or fear.
From Postural Fixation to Biopsychosocial Understanding
The episode contrasts the outdated postural structural biomechanical model with the modern biopsychosocial model, which accounts for psychological and social factors in pain, not just physical structure.
Neuroplasticity: The Brain’s Power to Change Pain
“You can gradually expose them to positions or movements that their nervous system perceives as threatening. And when you do that in kind of these baby steps, these graded steps, it's called graded exposure. You just gradually expose them to it.”
The Three Phases of Rehab: Inflammation to Remodeling
“During the inflammatory phase, I'm going to help kind of calm things down... After that, a few days out, they get in the maturation phase. I'm going to work on mobility and motor control. And then when they get out to a month and longer, I'm going to really then start thinking more about getting back to strengthening exercises.”
The Myth of 'Bad Movements' and the Power of Progression
“There are no bad movements. Most of us can, if we have a goal of being able to perform a particular movement or exercise, most of us can reach that goal with a program that builds that capacity up gradually.”
“any particular exercise or movement. Most of us can, if we have a goal of being able to perform a particular movement or exercise, most of us can reach that goal. with a program that builds that capacity up gradually.”
“So there's this mismatch, but then you devise a plan where you gradually expose them to positions or movements that their nervous system perceives as threatening. And when you do that in kind of these baby steps, these graded steps, it's called graded exposure.”
“So pain is an output of the nervous system. And there are cool studies where they'll do this with virtual reality, where they'll trick people. They'll use virtual reality and make them believe they actually kind of show like a knife cutting across their arm, but it's not actually on their arm. But because of the virtual reality, they think it is. And they will experience pain even though nothing's happening to them.”
Host
Guest
Dr. Tom Walters
person
Anthony Randa
person
Rehab Science
organization
Perform Better
organization
Victory
organization
Mike Boyle
person
Greg Cook
person
International Association for the Study of Pain
organization
FMS
organization
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