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Evidence-based practice has a blind spot: not in the research itself, but in how we rank one form of knowledge above all others.  In this episode, I sit down with physiotherapist and PhD candidate Matt Low to unpack what he calls epistemic fluency, the ability to move between different forms of clinical knowledge depending on what the situation actually requires. We cover why population-based research gives you a map but not your patient's territory, how Aristotle's three forms of knowledge apply directly to clinical reasoning, and why the biopsychosocial model functions better as an analytical tool than a practice guide.  We also dig into the Back Cafe — a 3-arm RCT on lumbar spinal fusion rehab that compared a progressive training program, a video program, and a social cafe setting run by a senior physiotherapist. At the 2-year follow-up, the back-cafe group outperformed the training group on pain and beat both other groups on daily task performance. The study raises hard questions about what the active ingredient in rehabilitation actually is.  This is Part 1 of 2.  LINKS  Join Modern Pain ProMatt Low's blogBack Cafe study (PubMed)CauseHealth (Matt's network) ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Most chronic pain patients aren't failing to improve because they aren't trying. They're failing because no one in their care has helped them see what they're actually up against. In this solo episode, Mark breaks down why even well-intentioned biopsychosocial care often falls apart in practice -- and why the fix isn't just adding more disciplines to the team. Key takeaways: -  What the Misdirected Problem Solving Model reveals about chronic pain care -  Why patients still separate the "body problem" from the "mind thing" even when seeing both PT and a psychologist -  How incoherent clinical narratives keep patients locked in biomedical thinking -  What true interdisciplinary care actually looks like vs. parallel care happening in silos -  How PTs can bring the psychosocial in -- and why psychology needs to bring the body back into the conversation -  What a unified clinical story sounds like in practice A free webinar is coming up focused on building this framework in your own practice. Registration HERE If this episode hit home, subscribe and check out Modern Pain Pro -- where clinicians go deep on exactly this kind of work together. - https://modernpaincare.com ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

What if the best thing you could bring to a complex pain case… is curiosity instead of certainty?In this episode, Mark Kargela sits down with physical therapist and pelvic health specialist Faith Stokes to explore what trauma-informed, psychologically informed care actually looks like in practice. When patients present with persistent pain, grief, trauma, or complex comorbidities, rigid clinical labels and quick solutions often fail. Faith shares how clinicians can step back, regulate themselves, and create space for the patient’s story to guide care. This conversation dives into practical ways to show up more human, grounded, and effective when treating messy cases that don’t fit the textbook. In this episode, you’ll learn: Why you don’t need to be “the expert” in the roomHow clinician nervous system regulation changes patient outcomesWhat trauma-informed care actually looks like during treatmentHow curiosity improves clinical reasoning in complex pain casesWhy acknowledging a patient’s story can transform rehabilitationHow to integrate psychological awareness without abandoning physical treatmentIf you treat persistent pain, pelvic health conditions, or complex chronic cases, this conversation will change how you approach patient care. Subscribe for more conversations on modern pain care, clinical reasoning, and treating complexity. Explore the resources and programs mentioned in the links below. Link: Sondermind Complex PTSD Book Holistically Treating Complex PTSD Book IG Post on Veterans  Stress and Suicide ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

What if biomechanics isn’t the reason your patients improve? And what if your best “tool” isn’t a tool at all? In this episode, I sit down with exercise physiologist Samuel Bulten to unpack the identity shift many clinicians face when persistent pain doesn’t respond to traditional care. We discuss: Why biomechanics has a weaker link to pain than we were taughtThe ego trap of being the “fixer” in the roomHow ACT and psychologically informed care change clinical conversationsThe tension between objective measures and meaningful life changeWhy therapeutic alliance may matter more than your techniqueHow rural practice highlights the limits of biomedical narrativesIf you’ve ever felt unsettled leaving school confident—only to feel lost with persistent pain cases—this conversation will help you recalibrate. If you’re ready to build confidence with complex pain, subscribe for weekly episodes. ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

What if the guideline isn’t wrong—but incomplete? And what if your patient isn’t “non-compliant”—just complex? In this episode, I’m joined by Joost Van Wijchen to explore the tension between clinical guidelines and the messy reality of practice. We unpack the concept of mindlines—the experience-shaped frameworks that actually guide what we do—and why uncertainty isn’t a flaw in care, but part of it. You’ll learn: Why guidelines are population-informed—but patients are personalHow “mindlines” shape clinical reasoning more than we realizeWhy outcome measures like the Oswestry don’t tell the whole storyHow the capability approach shifts focus from impairments to meaningful freedomPractical ways to navigate uncertainty without losing clinical integrityHow to co-construct care instead of imposing solutionsIf you’ve ever felt the tension between measurable outcomes and meaningful outcomes, this conversation will resonate. If this episode challenges or sharpens your thinking, subscribe and share it with a colleague. ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Mindfulness for pain isn’t candles and breathing apps. It’s measurable, mechanism-based analgesia. In this episode, we break down what the neuroscience actually shows about mindfulness and pain modulation—and why it works through pathways completely independent of opioids. You’ll learn: How mindfulness decouples sensation from suffering (insula vs. prefrontal activity)Why “trying to relax” can backfire—and what to cue insteadHow thalamic gating may reduce nociceptive input before conscious processingThe role of predictive processing and reduced anticipatory threat (amygdala + salience network)How shifting from narrative mode to experiential mode changes painWhy mindfulness still works even when endogenous opioids are blockedHow improved interoception supports emotional regulation in chronic painThis is not about turning your clinic into an eight-week meditation program. It’s about understanding the mechanisms so you can apply brief, practical strategies in real sessions. If you work with complex or persistent pain, this reframes mindfulness as a clinical skill—not a wellness add-on. Subscribe so you don’t miss Part Two, where we cover the dose-response data and the minimum effective dose. ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

What do you do when a patient says, “I don’t care about goals—I just want less pain”? This moment shows up every day in pain care—and how you respond can either reinforce stuckness or help someone get their life back. In this episode, Mark Kargela breaks down why pain reduction isn’t wrong—but often incomplete—and how clinicians can navigate this conversation without invalidating the patient or taking away hope. You’ll learn:  • Why pain reduction alone can narrow a patient’s life  • Red flags that someone is stuck in the pain reduction loop  • How pain scores function as communication—not thermometers  • How to use “creative hopelessness” without confrontation  • Ways to pair short-term relief with long-term valued living  • How to reframe goals when patients fear movement and activity This episode is for clinicians who want practical, psychologically informed tools to manage complex pain conversations—without abandoning pain relief or overstepping their role. If you work with persistent pain, this discussion will sharpen how you listen, how you frame goals, and how you help patients move forward—even when pain doesn’t fully disappear. 👉 Subscribe for weekly evidence-informed conversations on modern pain care. -  @ModernPainPodcast   👉 Explore the links below for related resources and deeper learning: Kenneth Craig Paper on Social Communication Model of Pain A biopsychosocial formulation of pain communication Creative Hopelessness Guide  ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

🎙️ What happens when a clinician becomes the patient—and almost doesn’t survive?  💥 HLH. ICU. Life support. Then… powerlifting again. In this powerful episode, strength coach and physio Jared Maynard shares his shocking journey through a life-threatening diagnosis of HLH, his fight to stay alive, and what he learned about healthcare, humanity, and healing. You’ll learn: What HLH is—and how it nearly ended Jared’s lifeThe deep clinical lessons from losing strength, speech, and independenceHow small human moments in care created lasting impactWhat it’s like to rebuild your life, body, and mindset after ICUHow Jared’s story reshaped his clinical work and coachingWhy “being human” matters more than “having the answer”Whether you’re burned out, feeling disconnected from your work, or want to show up better for patients—this story will move you. 👇 Subscribe for more clinician-to-clinician conversations.  🧠 Join the Modern Pain Pro community. 🎓 Explore Pain Practice OS and start applying modern principles. ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Part 2 goes from definitions to implications. Bottom-up pain does not mean “it’s in the tissues.” This episode is a recording of a live interview with pain researcher and clinician Asaf Weissman. If you haven’t watched Part 1, start there—we laid the foundation: why pain semantics matter, how mixed messages harm patients, and why “nothing is wrong with your body” is an overreach. In Part 2, we dig into: What “always bottom up” actually means (and what it doesn’t)Structural paradigm vs pathophysiology: why imaging often fails usWhy stress, fear, and emotions are usually modulators, not causesThreshold models: when trajectories may (and may not) be changeableThe case for neuroimmune mechanisms in chronic pain statesWhere diagnostics and biologics may take chronic pain care nextWhat role physios may play as case managers and guides This is the second half of a two-part series. Part 1 builds the framework. Part 2 challenges how we interpret evidence, scope, and clinical uncertainty—while staying anchored to what helps the patient in front of you. ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Chronic pain care is stuck—and definitions may be the reason. In Part 1 of this two-part series, we reset how clinicians talk about nociception and pain. This episode is a recording of a live interview with pain researcher and clinician Asaf Weissman, whose work explores the relationship between nociception and pain—and why confusion in the field creates real-world harm for patients. In this episode, you’ll learn: Why “just semantics” becomes a patient trust problemHow mixed messages (“all in your head” vs “tissue damage”) derail careWhy “nothing is wrong with your body” is an overreachWhere neuroimmune processes may fit in chronic pain biologyWhy psychological interventions tend to show only modest effects on pain intensityHow clearer definitions could move research and practice forwardThis is Part 1 of a two-part conversation. Here, we focus on the foundations—definitions, clinical frustration, and the biological plausibility behind what patients feel. Part 2 will go deeper into implications for treatment and the direction pain care needs next. Subscribe for Part 2. Join the Modern Pain Pro community. Enroll in Pain Practice OS. ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Enrolling our next cohort of Pain Practice OS soon - JOIN US! Most back pain improves – but how we guide recovery makes all the difference. In this part 2 conversation with Dr. Jim Eubanks, we dig into: First-line care for acute low back painWhy rest is often the worst adviceThe role (and limits) of hands-on careWhen and how pain procedures fit into a planClear guidance on when to refer to a physiatristNavigating complex cases that stall in recoveryFuture potential (and current pitfalls) of regenerative medicineThis episode brings clarity and clinical confidence to some of the most debated decisions in spine care. Subscribe for more evidence-aware guidance, and check the links below for show notes, resources, and clinician tools. ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

In this episode, Dr. Jim Eubanks, physiatrist and spine specialist, breaks down the most harmful back pain myths patients encounter online-and what clinicians can say instead. If you've ever struggled to help a patient move past catastrophic thinking or scary MRI language, this conversation will give you the tools to reframe pain, imaging, and recovery. What you'll learn: Why "pain equals damage" keeps patients stuck in fear and avoidanceHow to translate radiology reports into plain language that empowers movementWhen imaging is actually necessary (and when it's not)The role of lifestyle, sleep, stress, and psychological factors in back pain recoveryWhy rehabilitation should almost always come first-even before imagingThis is part one of a two-part series. Part two dives into first-line care, injections, procedures, and when to involve a specialist. 🎧 Listen to the full podcast  💬 Join Modern Pain Pro for mentorship, case discussions, and clinical resources → modernpaincare.com 📘 Learn about Pain Practice OS → Our flagship program for clinicians building local pain programs Your work matters-let's build modern pain care together. #BackPain #PhysicalTherapy #ChronicPain #PainScience #Physiatry #RehabFirst ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

In this episode, I sit down with Mark Shepherd, fellowship program director, to tackle a controversial question: Is the "manual therapy" label holding back our profession? We explore whether orthopedic manual physical therapy should rebrand itself as the research evolves and public perception shifts. What we cover: Why fellowship training is about reasoning, not just techniqueThe disconnect between what OMPT actually is vs. how it's perceivedHow branding affects patient expectations and clinician identityWhether the manual therapy name limits our ability to attract new fellowsThe role of touch in modern pain care—and why it shouldn't define usThis is a nuanced conversation between two fellows who deeply respect the training but question whether our messaging matches our methods in 2025. 🎧 Modern Pain Care Resources: Join the Modern Pain Pro community Learn about Pain Practice OS #PhysicalTherapy #ManualTherapy #OMPT #PainCare #Fellowship #PainScience #Physio ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Try Pain Coach  Connect with Lachlan on LinkedIn Struggling to turn complex chronic pain into simple, actionable care plans your patients can follow? In this episode of the Modern Pain Podcast, Mark sits down with physiotherapist and Pain Coach founder Lachlan Townend to unpack how lifestyle data, clinical reasoning, and tech can finally work together instead of against each other. Lachlan shares his own journey with persistent groin pain, why the traditional biopsychosocial model often becomes “woo-woo” and unmeasured, and how he built Pain Coach to help clinicians track sleep, exercise, social connection, nutrition, and psychological distress in a way that actually guides treatment. You’ll hear us dive into: How Lachlan’s personal pain story shaped his empathy and practiceWhy patients don’t want “complexity” – they want simple, actionable stepsThe limitations of manual therapy and short-term fixes (without throwing them out entirely)How to use lifestyle tracking as a clinical support tool, not a replacement for reasoningUsing data to test-treat-retest lifestyle changes over timeThe tension between research, incentives, and real-world outcomesHow AI could help clinicians ask better questions of their patients’ dataIf you’re a physio, PT, chiro, OT, pain coach, or any clinician working with persistent pain, this conversation will give you a concrete way to move beyond the “magic hands” model and into measurable, whole-person care. ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

In this episode, Mark sits down with Richard McIlmoyle, a chiropractor from British Columbia who went through a profound professional transformation after discovering modern pain science. Richard shares his journey from biomechanical certainty to embracing uncertainty, and how that shift has made him a better clinician and mentor. In this conversation, you'll discover: How to mentor students without destroying their foundational confidenceWhy intellectual humility is your greatest clinical assetThe tension between what we're taught in school and what science actually showsHow Richard approaches manual therapy from a macro-down perspectiveWhy he audited UBC's medical school pain curriculum (and what he found)Richard's story is a masterclass in professional evolution. From attending the San Diego Pain Summit in 2015 to now influencing medical education in British Columbia, he demonstrates what's possible when clinicians choose curiosity over certainty. ********************************************************************* 📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/ 🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/ 🎙️ - Listen to our Podcast - https://www.modernpaincare.com ____________________________________ Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness