The Thinking Practitioner Podcast:
Episode 51: Neuroinflammation (with Todd Hargrove) 

©Copyright The Thinking Practitioner Podcast, Til Luchau & Whitney Lowe

Whitney Lowe:

Welcome to the Thinking Practitioner Podcast.

Til Luchau:

A podcast where we dig into the fascinating issues, conditions and quandaries in the massage and manual therapy world today.

Whitney Lowe:

I'm Whitney Lowe.

Til Luchau:

And I'm Til Luchau.

Whitney Lowe:

Welcome to the Thinking Practitioner. Hi, this is Whitney Lowe and thanks for joining us on the Thinking Practitioner Podcast, where Books of Discovery has been part of the massage therapy education world for over 20 years. Thousands of schools around the world teach with their textbooks and digital resources and in these trying times, this beloved publisher is dedicated to helping educators with online friendly digital resources that make instruction easier and more effective in the classroom or virtually.

Whitney Lowe:

Books of Discovery likes to say, "Learning adventures start here." They see that same spirit here on the Thinking Practitioner Podcast and they're proud to support our work, knowing we share the mission to bring the massage and bodywork community enlivening content that advances our profession.

Til Luchau:

Check out their collection of E-textbooks and digital learning resources for pathology, kinesiology, anatomy and physiology at booksofdiscovery.com, where Thinking Practitioner listeners save 15% by entering, "thinking" at checkout. How are you doing, Whitney?

Whitney Lowe:

Very well today, sir. How are you doing?

Til Luchau:

Excellent.

Whitney Lowe:

Good to have you back here. I was off and I missed you deeply last week.

Til Luchau:

You were solo. Thanks for doing that.

Whitney Lowe:

Yeah. I had a good talk with Jamie Johnson and Eric Purvis from Canada. But we missed having you there and great to see you back. You've been rafting from what I understand, right? Down the river.

Til Luchau:

Rafting down the Green River in Utah. Rafting up wind, it turns out. My biceps got a real workout. Paul Kennedy, I was totally thinking of you on that trip. But it was fun to be away. So thanks for covering for me.

Whitney Lowe:

Yeah, absolutely.

Til Luchau:

We're not alone. Today we have an exciting guest.

Whitney Lowe:

All right. Let's hear about it.

Til Luchau:

Todd Hargrove, thanks for being with us. You have a blog and podcast of your own, Better Movement. I'll say a little bit about it. We actually haven't met until just now. But I heard your name a long time ago. Someone said, "Til, you should meet this guy, Todd. He's got some background in Rolfing and he thinks different like you're thinking different," or something like that.

Til Luchau:

I said, "Okay, that sounds cool." And then it was Greg layman who first said even more, he talked about how you were giving him a hard time for being a movement nihilist, which I thought was a really interesting and good point.

Whitney Lowe:

Yeah.

Til Luchau:

So then yeah, I've never actually had the chance to catch up with you. I'm excited to talk to you. You actually wrote a fun little article about neuro-inflammation. I'll let you talk in a second, but the concept there of the neuro-immune system is really fascinating. How, at least this is my take, I want to hear yours but the take of how the immune system and the nervous system work together and are both parts of say, a bigger hole, a bigger function that is basically about protection.

Til Luchau:

That might even include social behaviors and such. But anyway, that's my interest. That's what piqued my interest and you touched on a couple of those things in your article about neuro-inflammation. Now that I've said all that, what do you want us to know about you before we dig into some of those things?

Todd Hargrove:

Well, first I'm happy to be here. Thanks for inviting me. I've heard your name for a long time too. I've met Whitney before, but this is my first time meeting you. Yeah. I do have a background in Rolfing. I've gone all the way back. I've a background of being an attorney. I was doing that for about 10 years and then I started to experience some chronic pain which got me interested in the body and why it might be hurting.

Todd Hargrove:

I was already interested in the body from playing sports. That got me kind of interested in movement, both of those things, because around the time I was getting into this stuff was around 2005, there were a lot of athletic trainers that were talking to physical therapists and physical therapists who were talking to athletic trainers.

Todd Hargrove:

The idea was that the way you move is related to the way you feel. I just found that really interesting. At the same time, I was looking into yoga and martial arts kind of stuff and different functional training things. I got a session of Rolfing done by a guy named Brad Jones here in Seattle. I had a great experience doing that.

Todd Hargrove:

Anyway, long story short, I started to move a lot better, I started to feel a lot better. I got interested enough in the whole thing that I was like, "I'd rather do this than be an attorney." So I went to school to learn how to be a Rolfer in 2005.

Todd Hargrove:

Shortly after that, I did some extra training to be a Feldenkrais practitioner. I've been doing both of those things, practicing in my own Rolfing-ish, Feldenkrais-ish way for I guess about 15 years, seeing people here in Seattle and also doing some writing on a blog at Better Movement and now Todd Hargrove at Substack and writing a few books and coming into contact with other people like you guys and talking geeking out.

Til Luchau:

Cool. Well, we'll make sure we get links to all that stuff in the show notes. But that's great to get a picture of your course into this stuff and what an interesting combination of influences. You did the Rolf training first and then went and trained as a Feldenkrais practitioner.

Til Luchau:

That's a small set of people that includes some of my mentors. I trained with Thomas Hanna about the same time I was training with students of Ida Rolf at The Esalen Institute in the '80s. That was always a big influence in my thrust as well. So it's interesting-

Todd Hargrove:

Well, there was Schleip too, Robert Schleip. When I was at school, that's when I first came into contact with his work and that I found influential. He's a Feldenkrais guy. His idea that what we're doing with Rolfing is kind of actually to use the phrase, I think it was one of Feldenkrais' students, he said that what we're doing here is about information, not defamation.

Todd Hargrove:

That was kind of like Schleip's idea as well, is that when we're putting an elbow on somebody, it's not about melting and deforming in as much as it is sending information and asking for permission and that idea is kind of like... That paradigm is really kind of the way I've thought about body work and different types of movement work.

Todd Hargrove:

That's what led me to really thinking about the nervous system. Really, really thinking about the nervous system. It was kind of later that I came to appreciate it a little bit more that hey, the immune system works really, really, really closely with the nervous system. This idea of neuro-inflammation is expanding out from that base of thinking a lot about the nervous system.

Til Luchau:

Tell us some more about how you got interested in it, why you took the time to write a blog piece about it. Especially how it relates to manual therapy, we'll get into that too as we go along, if you like.

Todd Hargrove:

Back to the neuro-immune system idea, what I became interested in with chronic pain... Well, my first idea of why something hurts that I had when I was hurting and when I first got started practicing is there's something wrong with the body. If your knee hurts, there's something wrong with the knee, if your back hurts, there's something wrong with your back. That's not necessarily wrong but it's only part of the story-

Til Luchau:

Something wrong like damage or being used poorly.

Todd Hargrove:

Damaged, like there's something wrong with your knee, there's damaged something in the knee. There's something wrong with your back, there's damage in the back. But as I learned more, it's also about the sensitivity of the nervous system, how it's reading information from that area and it can be sensitized and rid more of the threat than is actually there. I found that idea very interesting.

Todd Hargrove:

You study more and you realize that a lot of what's getting the nervous system sensitive is the activity of the immune system. Very obviously, one obvious idea would be peripheral inflammation. If you're inflamed in your knee, that's sensitizing the nociceptors in the knee and changing the sensitivity of the nervous system. But you can also have inflammation within the nervous system, within the central nervous system. That's basically what neuro inflammation means is inflammation in the central nervous system and that can change the sensitivity of the nervous system as well.

Til Luchau:

That's an important distinction, I just want to underline for a second there. You are talking about how peripheral inflammation in your knee can sensitize the nociceptors there, the nerve endings there, so they generate more signal perhaps or the signal threshold is lower, whatever it is. But then you're making the distinction saying like in the central nervous system, that could be going on too. There could be inflammatory mechanisms at work that make us just more sensitive overall as well may be more reactive.

Todd Hargrove:

Yeah. Yeah. Part of what I learned is that in the brain for example, only about something like 10% of the cells there are neurons that are conveying the electrical information. Many, many, many of them are the glial cells and they're holding the neurons in place and giving them nutrition and helping with transmission and repairing damage and stuff like that.

Todd Hargrove:

They play a role in helping the neurons do what they do. They might be involved in learning and memory. Again, they can sensitize the transmission of nociception. There's a balance there. They have an important role to play in keeping everything healthy there. Some of them are microglia, that are kind of like looking for infections and repairing damage and always surveying their environment.

Til Luchau:

Some immune cells of the brain as it were.

Todd Hargrove:

Yeah, yeah. But when they are excessive at what they're doing, just like the inflammation throughout the body, inflammation plays a valuable role in clearing infections and repairing damage, it can become chronic, it can become more excessive than it needs to be to get the job done. That can play a role in bad health, in the periphery and the same applies to the central nervous system.

Whitney Lowe:

I'm curious. Todd, when you say, the inflammation within the central nervous system causing sensitization elsewhere, would we tend to see that show up as overall greater sensitivity to all kinds of sensory stimuli throughout the body or let's say, a person's knee hurts and maybe there's some relationship there with neurogenic inflammation or within the nervous system, where that inflammation is occurring. Does that tend to show up in broader areas when it's within the whole nervous system as opposed to like a small local peripheral instance?

Todd Hargrove:

Yeah, I understand that the central sensitivity that can happen at the dorsal horn is partly mediated by the activity of glial cells around there. I should point out that all of this discussion of the immune cells and all this physiology is super complex and I'm just kind of starting to learn about it and there's a... You read one of these papers on neuro-inflammation and you encounter 10 and 20 and 30 descriptions of different kinds of cells that are involved, like the IL-6, the IL-7 up to IL-10. All of them do slightly different things.

Todd Hargrove:

So it's an enormously complex system. I'm just kind of scratching the surface here in terms of my knowledge of what's going on at the micro level. I think of this as kind of like an interesting part of a larger picture, which is that the nervous system works with the immune system, works with the endocrine system in protecting the body. There's just a wide variety of bad feelings we can have that are associated with one or more of these systems getting over protective.

Whitney Lowe:

Yeah, yeah. You, on a recent episode of your podcast, had a really good interview with Brani Thompson, where you were talking about fibromyalgia and some of those other widespread body pain problems, possibly being somewhat linked to some of these concepts and ideas. Is that correct?

Todd Hargrove:

Yeah, that's right. One of the interesting things about neuro inflammation and the reason why I say it's kind of like a... If you were going to look at any one kind of micro piece of this big picture that I think is easier to understand, that micro peace would be neuro inflammation keeps showing up if you look for it in the brains of people who have a wide variety of chronic complex health conditions like chronic pain, fibromyalgia, chronic fatigue, Alzheimer's, Parkinson's, cognitive problems like dementia.

Todd Hargrove:

It keeps being there wherever you look for it, kind of like the way chronic inflammation is there in a lot of different chronic health problems that are more peripheral in nature. It's something that starts to catch your attention after a while. It's kind of a common player, a common currency in these things. I think that we should kind of have our eye out for that term and be looking for it. Because once you start looking for it, you'll be seeing it in lots of different places.

Whitney Lowe:

Yeah.

Til Luchau:

Let's not miss the chance to clarify some of those signs. You named a few conditions there that we're really starting to wonder or suspect or see that neuro-inflammation can play a role. But what are some of the other signs or client complaints or issues that you'd say, "Maybe that's one of the mechanisms at work here."

Todd Hargrove:

Well, I think those ones that I just mentioned are the ones that I know about. But when you see clients that have conditions that have been going on for a long time not easily explained or reduced to a particular diagnosis, but they've been to a lot of doctors, they're wondering what it is, their symptoms seem to come and go without rhyme or reason. Maybe the symptoms seem to be related to a traumatic event that happened either emotional or physical, or it happened after a serious infection.

Til Luchau:

There you go.

Todd Hargrove:

Or if there's auto-immune components involved, if there's anxiety or depression involved, if you see a lot of people who have had problems for a while they're not sure what they are, it becomes more and more likely that they have one of these conditions. Anytime you have one of these conditions, it greatly increases the chances of having some of these other conditions. So they all kind of run together, some of them are more recognized as a disorder of the nervous system.

Todd Hargrove:

One might be more about the immune system, like auto-immune, one might be kind of like an endocrine system thing. But all these systems really talk to each other. One being in a regulated balance state is necessary for the others to be as well, which is maybe why all of these conditions can be kind of comorbid.

Til Luchau:

With the common thread being the probable inflammation, inflammatory activity in the central nervous system, increasing the sensitivity and the reactivity of those responses, with pain being one of those signs. Pain out of proportion to stimulus, perhaps or reactivity out of proportion to the noxious stimulus-

Todd Hargrove:

Yeah, yeah. Or fatigue out of proportion to the amount you're exerting yourself or worrying out of proportion to the amount that there's really something to worry about or being sad, more than a normal person would be sad under the circumstances. Those are all... I like to think about all the different ways that the body can protect itself from perceived harm. One of them is sleeping. Your body's always protecting itself against running out of energy.

Todd Hargrove:

It needs to make you tired and make you go to sleep when it perceives that energy stores are low. Pain is there to get you to stop moving and protect something. Anxiety and worry and low mood are there to get you to start thinking about how to solve problems. All of those protective mechanisms can start to become maladaptive and over protective. Anytime you look at one of them, you see neuro-inflammation involved.

Whitney Lowe:

So I'm curious too. It's fascinating physiology to delve into this. Those of us who are kind of geekly interested in this kind of stuff can really get down a rabbit hole with it. But from a day to day clinical perspective for the practitioners who are out there in the trenches doing stuff, are there any real key indicators or signs or symptoms that you can describe as something that would point to a greater involvement of something like neuro-inflammatory activity within the central nervous system or something?

Todd Hargrove:

Yeah. When people have pains that are not well localized, they move around, they're just not well correlated with what you would suspect would be tissue damage in an area. Now, like if someone comes in and says, "I twisted my ankle last week. It hurts right in that exact spot now and it hurts when I move it like this," then that's like maybe the prototypical example of a pain that's obviously related to a local tissue damage problem.

Whitney Lowe:

Yeah.

Todd Hargrove:

But when you've got pain-

Til Luchau:

Or tissue sensitivity problem, at least.

Whitney Lowe:

Yeah.

Todd Hargrove:

Tissue sensitive, yeah. But when you've got the pains that move around and they're also connected to psychosocial issues, and they're connected to energy level issues, there's also comorbidities of the kinds that I just talked about with the anxiety and the depression and the auto-immune disease. That's when I start to suspect we've got more kind of a systemic dysregulation type of situation. It gets me thinking much less about targeting that local area where it hurts and much more about general health and just kind of helping people troubleshoot and strategize and think about ways in which they might be able to improve their general health and the obvious things here are the way you sleep, the way you eat, the way you exercise, reducing stress, optimizing your weight, avoiding toxins like alcohol, drugs and pollution.

Til Luchau:

You just gave the punch line to the whole joke. That's what all this is building up to, I know. But let's back it out a little bit and keep looking at what goes on there because I do want to make really clear that distinction between say, chronic pain in general or other kinds of pain syndromes and neuro-inflammation, which might be just one explanatory factor or mechanism there. They're different. But we're kind of talking about them as if there's similar. There are a lot of similarities but that classic distinction you mentioned too, like a pain that moves around. That's such a clear example sometimes. Sometimes to clients or patients too, that well maybe it isn't just the tissue that's part of this.

Til Luchau:

If something hurts and then it changes quickly, wow, maybe it wasn't because the tissues injured after all, maybe it was more of a sensitization of our nervous system and all of that.

Todd Hargrove:

Yeah, they can understand that. Part of helping people who have, I would think of as being this more systemic general health issue, part of helping them is helping them understand that that's what it's about. A lot of them will. They've been to a lot of doctors and they know that something is going wrong besides just something being out of place somewhere.

Til Luchau:

Well, yeah. What you're saying though is really important. You're asking us to think generally about general symptoms. You're asking us to think systematically about symptoms that seem to be transitory, move around, influence the whole way someone's feeling.

Todd Hargrove:

Yeah. Yeah, I think there's kind of like two mindsets. There's certain types of problems which are complicated problems, which are the kinds of problems that mechanics fix in cars. So someone's got a problem with their car, it's making a noise, it's not running, you take it in and the mechanic is able to identify the one thing that's wrong, use their special tests and identify that one factor out of the many different interrelated factors in that engine, which has got going a problem and then intervene on that one thing in relative isolation to all the other things and clients come in and they want that.

Todd Hargrove:

We want to do that as therapists as well. And occasionally, we can do that when they've got that really peripheral type of a problem. But when they've got the type of a problem, which is more systemic, which is more about dysregulation, which is more about the way many, many, many different things are relating to each other. The problem is more like, I like to think in terms of analogies of maybe what's going wrong in our society with polarization. What's the one thing that's wrong there? I don't know man. That's a dynamic problem. That's lots of things.

Todd Hargrove:

If you intervene on any one part of that system, you probably won't solve the whole problem and the system's just going to just get to stabilize in whatever kind of attractor state that it's in and complex health problems can be like that, so you shift your mindset to much more higher level, not the micro level, but kind of like the higher level general health kind of stuff.

Til Luchau:

Well, you mentioned mechanics and so I've got to weigh in there because I was a mechanic for a while.

Whitney Lowe:

I didn't know that.

Til Luchau:

Yeah, in college. I worked my way through college as a foreign car mechanic with a fuel injection specialty.

Whitney Lowe:

Cool, can I bring my car over to you?

Til Luchau:

We can talk. But here's the deal. Not even if that cause and effect is linear, is mechanical. Any good mechanic can tell you all sorts of strange stories that are clearly systemic or system phenomenon, going on-

Todd Hargrove:

Really?

Til Luchau:

Yeah. Oh, yeah.

Todd Hargrove:

Interesting. I've got to maybe change my example there.

Til Luchau:

Well, I mean, it's a flat tire. You've got a nail, you take it out, it's clear. But as practitioners, we want to find that nail. We always want the one thing. And the clients or patients want that too. They want to know what is that problem.

Til Luchau:

But in the case of a flat tire, it might be clear. Especially when you start getting into engines and there's electronics involved, it's a complex situation. There can multi-causal and multi-variable. And to tease that apart, involves that kind of higher thinking you're thinking about, or at least, a backing off away from looking for the one cause and the one fact and being open to more systemic influences. There's sometimes even just as simple, but there is a bigger picture.

Todd Hargrove:

I think it'd be kind of zooming out, zooming out my perspective. I like to be aware of so many different ways to look at pain. One of the distinctions I like is sometimes you're looking at a micro level, you're looking at what's happening with cells. Some of what you can stay with neuro-inflammation and some is the really zoomed out person level where you're thinking about the person's mood or their intentions or things like that. It's kind of nice to know where you are in your zoom level and know how to toggle back and forth.

Til Luchau:

And to understand that all these things are connected. You talked... The emotional states are another part of the protective or reactive system that we have, you're describing there. We've got the nervous system, which helps us change our behavior around pain. If it's hot, we pull our finger out of the fire. We've got the immune system, which changes behaviors of cells and fluids and signaling devices inside of our body to protect us in different ways. And then we have... I don't want to go too far with this. You mentioned polarization, but you have the social immune idea too, which has some interesting things to say about xenophobia or ways we perceive others or even civilization as an infectious disease mechanism, control mechanism.

Todd Hargrove:

Yeah, yeah. Well, the whole COVID thing is a great analogy for the body freaking out when there's a major infection or there's some sort of major trauma, all these different protective systems get activated. One tends to hype up the others and there's this positive feedback loop. That creates the emergency response, for better, for worse. There can be a PTSD thing too, with what's supposed to happen after these protective systems get activated is that they should take care of the problem. And then there should be an all clear signal issued by the system, which tells all these protective systems when to start calming down again.

Todd Hargrove:

There's going to be a time, hopefully soon, when we don't need to wear masks. But a lot of people will continue to wear them because they've got some kind of PTSD. That happens in the body too.

Whitney Lowe:

Yeah. Todd, I'm curious for your thoughts on this too, in terms of trying to find some resolution for some of these kinds of issues. What you said a moment ago, you and Til were talking about the mechanic analogy. And I got me thinking too, in terms of the way that the healthcare system is set up, at least in our country and in a number of other countries as well, to look for those really narrowed-down fine problems so that you can have a particular diagnostic code and get your insurance reimbursement for that.

Whitney Lowe:

That also leads the treatment for those problems to become, in many instances, overly narrow, focused on one particular type of site or problem, which may be only a piece of the more global picture. What I wonder is it seems like a lot of these other sort of, if we call them alternative practices, which involve all the stuff that we do: massage therapy, body work, Rolfing, Feldenkrais, all those kinds of things, which are more global interventions, which might address a number of different parts of the body simultaneously, trying to look at more big picture treatments.

Whitney Lowe:

Is that one of the reasons maybe that these kinds of approaches tend to be more effective with some of these kinds of things than a lot of the other approaches that are more narrow, because a lot of people are quite dissatisfied with what happens in the traditional healthcare system trying to get these kinds of things addressed.

Todd Hargrove:

Yeah, I think that's absolutely right. If you go to the alternative healthcare people, they tend to be more "holistic", they look at more high level things, they're more integrative thinkers. When you get the medical science, they tend to be more under the microscope, it's a little bit more reductionistic. There's trade offs from those two different perspectives when you look at something on the microscope, you can be extremely precise, and measure exactly what's going on and be very confident that what you're describing is the reality. The higher level more complex entities you look at, there's kind of less precision. It's harder to measure what's happening, there's so many variables, you can't measure them all, you use kind of a more fixed terms to describe what's going on like perception of threat or-

Todd Hargrove:

You use more kinds of metaphors to understand what's going on. You gain the advantage of seeing more of the picture, but you're seeing the whole picture in less resolution and with less measurement and precision. Yeah, when that reductionistic biomedical perspective fails, that's when people go to alternative people who are going to have no problem talking about how thought is related to emotion, is related to the immune system, is related to what you eat, and all this kinds of stuff. That might not be so easy to measure and make sense of when you're going for the biomedical science. I think these two different levels need to talk to each other as much as possible so they can help each other with the strengths and weaknesses.

Whitney Lowe:

Yeah. A whole lot more. Getting out of our silos and learning some multiple languages and interaction skills for sure.

Todd Hargrove:

Yeah.

Til Luchau:

There's so much that is being done and so many ways that those conversations are happening. That, what you described there, is the kind of classic stereotypical siloing of our complimentary or conventional ways of looking at things. But I just remember going through my own chronic health condition with chronic Lyme disease, saw dozens of practitioners and then looking back after it finally resolved for me, there was not a clear distinction between conventional and complementary in terms of how they dealt with me as a person or with my emotions.

Til Luchau:

Some of the most emotionally inclusive practitioners were the most conventional, interestingly enough. Some of the most dogmatic or reductionist ones were the most "alternative" as well.

Whitney Lowe:

Interesting.

Til Luchau:

Yeah. It's something like you said about the willingness to step back and think there could be lots of factors here, including the way just people feel and think about it and behave as well as these very clear chemical mechanisms.

Todd Hargrove:

Another thing about the way people feel and think and behave and that just relating to people in the person level, that's one of the most actionable levels. If you're relating to someone as a person, not only are you understanding the role that emotions and thoughts play and how they're doing, you're working at the level where you might actually be able to affect them and affect their behavior. You can measure what's going on under the microscope but that doesn't tell you how to change behavior.

Til Luchau:

Lots there. Lots there. You're just making me think about all the interest now and say, co-regulation and Porge's work about how it's the connection that helps us regulate our autonomic state, etc. Anyway, that wasn't what the conversation was going to be about, but that's where my mind just went for sure.

Todd Hargrove:

Yeah, yeah. And like this idea of there being excessive levels of protection, it's something that informs a lot of your interaction because kind of like a baseline idea with someone that I'm working with is that I want them... I just want to give them as much good news as possible about their body. Anything that's... Based on the truth, not based on false promises or lies or anything like that. But if they have some range of motion that they didn't know they have, I want them to know that it's there.

Todd Hargrove:

If they have some reasonable hope that something can get better when they don't currently have that hope, I want them to know that. For example, you've got the people, I've got the knee of a 70-year-old, I can't run. I've got good news for you. I don't think that's true. Let's talk about the science about that or people who think that they can't bend their back in a certain way and you can kind of show them that that's possible. Or you could just show them that someone cares about them and is going to listen to their problems or just something they might not know, unfortunately, even after I've been to a lot of medical professionals before and just all of that good news is just a way to lower the threat, one way or the other.

Todd Hargrove:

To me, that's like a baseline thing we can do.

Til Luchau:

You're talking about that basic way of mirroring or reframing people's experience back to them in a way actually could help them shift the way they think about it as being okay, as opposed to being flawed or damaged.

Todd Hargrove:

Yeah.

Til Luchau:

Yeah. You're talking about building capacity and building trust and resilience in people's own capabilities through a sense of what they have. It's so subtle what comes through because in our tradition as Rolfers, it was so common to feel something, "Oh, yeah. I feel that. Geez." Basically saying all 15 different ways, "You're messed up here. Oh, yeah. I feel that. Oh God. Geez. We're going to deal with that," or whatever. Which has always been one of my pet peeves having been on the receiving end of that and going, "Well, what's he feeling? Oh God, I didn't know I was messed up there."

Todd Hargrove:

Yeah, well, that's kind of like giving people bad news, I guess. But you could draw people's attention to the good things that are going on in the body that they might not have noticed, like that kind of thing as well.

Til Luchau:

Absolutely.

Todd Hargrove:

You can also communicate to people that here's something that might be useful from time to time is that they want to take care of this physical problem they've got in their body. Everyone knows that sleep is good for you. Everyone knows that you're not supposed to do drugs and stuff like that. But if they understand that, there may be more connection between these things, then they can maybe be more motivated to work on those types of things.

Todd Hargrove:

I've had some people that are like for example, they're not doing their daily walk. "I used to like to walk a lot. I don't really have time for it now. I liked it, because I got out in nature and it was a little bit of exercise every day."

Todd Hargrove:

Sometimes they're interested to know, you know what? Putting that half an hour walk back in every day might be part of solving the problem that you've come to me to get solved, which you didn't realize was connected to things like walking because these things are connected.

Whitney Lowe:

Do you think the challenge of trying to get some of this kind of stuff across really needs subtleties and fine points of communication that are oftentimes not polished in many of the practitioners who might be seeing a lot of these people.

Whitney Lowe:

It seems like one of the challenges that I hear and notice a lot is sort of unskilled attempts at trying to give lifestyle advice and guidelines and things like that in ways that are empowering for people, but not either blaming them or putting them into a pathological mindset and that kind of thing.

Todd Hargrove:

Yeah. There's definitely a lot of skill there and you can develop it a lot. But everyone's got people skills that sometimes we get confused by thinking, "I've got to be a psychologist," or something like that. But we're all people and we've all got tons of people skills, more than others.

Todd Hargrove:

I do think that one common mistake that gets made that I certainly made a ton is just like you said, is the kind of the blaming and the thinking that they just need more information. I think once you learn something about motivational interviewing, that really can set you straight.

Til Luchau:

Yeah.

Todd Hargrove:

Just as indirect approach.

Til Luchau:

Indirect approach, can you give an example? Can you say...

Todd Hargrove:

Well, it's just... For example, most people are not overweight because they don't understand that being overweight is bad for their health. You can't help people by saying, "Hey, you know what? That's really unhealthy." Or you can't say, "Hey, you know what? You'd be healthier, if you exercise." And stuff like that.

Todd Hargrove:

I'm going to have to ask, and you can't just give people certain motivations and change their behavior, you've got to work with wherever, whatever their current level of motivation and behavior is and understand that change is hard and it only happens with a certain amount of commitment. You've got to kind of sense when people are ready to change and what direction they're maybe already wanting to move to change. They're like a ship that's moving in a certain direction, you can only alter it a little bit so you need to know where it's going.

Til Luchau:

That implies an appreciation for all the factors behind why it's going the way it is and a sense of timing and a sense of... One of my own personal working assumptions is that it's not as hard as we think it is. That's just a helpful assumption that I try to live from in my own sense.

Todd Hargrove:

Yeah. I think it's like there's something about complex problems that suggests simple, common sense solutions. It's kind of stuff that we already know. Sometimes the clients already know this stuff too but they've gotten distracted by looking for like what you said, before the nail and the tire, that really fancy complicated answer. And so they're kind of ignoring those more kind of basic general health interventions, which might maybe should be the focus of attention.

Til Luchau:

Okay. Here's the working question I work with too, how do we help people with those basic health considerations sleep, diet, activity, stress, probably a fifth in there. As manual therapists from the assumption that the act can actually be simple and straightforward and within our scope of practice. There's enormously complex and sophisticated ways of doing that. But there's also got to be really simple, direct, clear and within scope ways. What do you think?

Todd Hargrove:

I think the biggest lever you've got is just the information that these things could be part of your solution.

Til Luchau:

Information. Okay.

Todd Hargrove:

Most of my clients that get to me, this is just my kind of client are very well-resourced people, educated. They've got money, they shopped at Whole Foods, they're interested in health, they're already sold on all this stuff being good for them. That type of person, probably better resourced than a lot of people in the been able to do that. Probably a lot. There's a ton of people in the world that don't have the time, don't have the energy to be able to all of a sudden start exercising or eat better or have the money to do that or anything. So it totally depends on the person. But there are some people that are kind of like ready, willing and able to make some sort of change like this if they only know that there's a good reason to do it. Maybe you could help give them a good reason, that would be the easiest way to help someone.

Til Luchau:

Sometimes when they realize that they can be part of the solution too.

Todd Hargrove:

Yeah, exactly, exactly.

Til Luchau:

There's some simple things you could do like take a walk. That actually might be related to what you're talking to me about.

Todd Hargrove:

Yeah, yeah. And even easier than fixing the problem by taking a walk would be learning about the problem by taking a walk and just seeing how you feel. I have a lot of people that are like, "I used to feel better whenever, last year." And then I've gained from the history. You know what you told I remember you told me you were walking a ton last year and you had to stop that because you'd lost your dog or your job or something like that. I'm curious how you'd feel if you started walking again.

Til Luchau:

Whitney, do you see what he did? He just moved the goalposts a little bit though. They wanted a flat tire fixed and he just turned them into what investigators, into their own symptomology.

Whitney Lowe:

Yeah, that seems like a really interesting segue. We should have had this discussion right after our interoception piece that we did, because there's there seems like there's a lot of that going on there. A heightened degree of tuning into what they're feeling and how that's related.

Til Luchau:

What they're feeling, but also just reflecting on it. "Oh, yeah, I didn't feel better after that walk. Geez. Heck." Catching that.

Todd Hargrove:

Yeah. The thing about a complex health problem is that almost anything can potentially make it worse. People start to realize that when they've become sensitive people and then any disturbance in their environment starts to... They realize that that can bother them, they realize that sleeping in the wrong bed or eating the wrong foods can flare them up.

Todd Hargrove:

Well, that means that there's many, many, many different things that can make them feel better too and it's complex, it's individual. They're the only ones that's going to be able to learn what these things are. I want to make them curious about all these different influences and start exploring them, figure out which, which factors matter which ones don't. Because those are all under their control, too.

Til Luchau:

What do you two think about the idea that we are, in some ways models, that we just by who we are, inspire a certain approach or being or a way of being with our own bodies, for example. Is that like-

Whitney Lowe:

Well, I think clearly people look to us to be those models, for them whether or not we kind of see ourselves that way or intend to, I think it's a natural process of somebody when you're going to seek care from some individual that you're looking to them to be some type of a model of better care and better health that you would want to aspire to.

Todd Hargrove:

Some of my clients, my story is there that I used to be in a lot of pain and now I'm not. Sometimes I'll frame what I think they might try to do in terms of what I would do. I might say something like, I don't know if this is a good idea but I'll very often say, "If I were in your position, I would be curious about how strength training would help that shoulder." Like if I had this problem, that's one of the first things I'd try. I don't know if it would work. But you know what I mean? I don't know if that's a good way to talk about it but sometimes, I will talk that way.

Til Luchau:

Sounds good to me.

Whitney Lowe:

Yeah.

Til Luchau:

Sounds good to me. Well, it puts you in the equation that you are owning it and you're offering it as an option for them to try and own if they want to. I'm just always aware, too, that when people finally do find a place in my schedule, pay my fee, get to see me, come to see me that they've already invested a bunch into their own feeling better. They've already performed a bunch of the setup for this important ritual we do, getting people on our tables and working with them. It's such an honor almost to be the... I almost think about it like I'm not a football guy so I'm probably going to blow the analogy, but the guy that comes and kicks the field goal. It's all been set up and I just show up and do that one thing, gets the point or whatever. But there's so many other factors there.

Todd Hargrove:

Disrespectful for the football kicker, you disrespected yourself and the kicker.

Whitney Lowe:

And for him, as long as you make the kick too.

Todd Hargrove:

Yeah. That guy could be-

Whitney Lowe:

The hero or the GOAT.

Til Luchau:

Maybe it's a bad analogy then because you're right. It turns it down either making the kick or not. Sometimes it is just being together and just hanging out in a cool situation and feeling better. It has the effect that we're both looking for.

Whitney Lowe:

Yeah.

Til Luchau:

All right, so before we wrap it up, I just had a couple of interesting things. You talked about cognitive functioning in your article, the brain fog thing is something people are thinking about a lot.

Todd Hargrove:

The brain fog, I'm not sure I've ever experienced that myself so when people say that they've got brain fog, I'm not exactly sure what it means. But a lot of people say, "I've got brain fog." And they mean they're having cognitive difficulty and it runs along with especially it seems like chronic fatigue and post viral type things and along, COVID people say that they've got brain fog. I think that they've found that people with Alzheimer's, cognitive decline and self diagnosed brain fog have higher levels of neuro-inflammation when they look at that under a device, they can find it.

Til Luchau:

As of chronic Lymes, a former chronic Lyme sufferer for sure brain fog was my friend, my constant companion. I knew exactly what they meant and it makes a whole lot of sense to me that as the body is recovering from or responding to or reacting to an infection, that has ongoing effects in the immune system or otherwise, we don't know that there are cognitive effects that you just can't think as well. There's some interesting research that explains how pain goes into and such where they talk about how different inflammatory cytokines increase our cognitive abilities and others reduce it.

Til Luchau:

The tendency being is the more inflammatory things are, the worse our space Memory is, the worst things like that are and the more anti-inflammatory, the clearer and quicker operations get. It's a generalization they play off of, but it made a whole lot of sense for me having gone through that. And air pollution. I don't want to miss that one. You mentioned that in your article as well.

Todd Hargrove:

Air pollution is just incredibly bad for you. It's unbelievable how much research there is out there. Some of it, very kind of interesting, some of the very kind of factoidy. There's so many different ways that they've tried to measure how it's bad. I think referees make more mistakes on days with high air pollution and judges get crossed more often in their decisions and people don't do as well on tests when there's high air pollution. And then population levels, you can find all sorts of health discrepancies based on how much air pollution there is.

Todd Hargrove:

But the cool thing about air pollution is it varies by day in certain cities and then so you can track certain types of things. And then they've got certain... I think they've got kind of a mechanistic understanding of how it kind of gets in there and crosses the blood brain barrier and causes the neuro-inflammation. It's not really for us massage therapists to be able to correct the air pollution but in the voting booth, that's an important thing to get done. I suppose that there are ways you can probably modify your local air supply-

Til Luchau:

Local environment, certainly behavior like in the voting booth, in the driver's seat or whatever it is, the choices we make.

Todd Hargrove:

But I mean, in your house, you can get air filters and stuff like that. I haven't looked into that too much. But I guess I concluded that my air is pretty healthy in my house right now. But I was thinking of getting one of those machines.

Til Luchau:

You're in Seattle?

Todd Hargrove:

Yeah.

Til Luchau:

So you got that great Puget sound effect going on there and all that-

Whitney Lowe:

Except for the summer. Everything's on fire.

Todd Hargrove:

Well, we lucked out this year. We did not have that much smoke. How did you do?

Whitney Lowe:

It was awful. It was really bad this year.

Til Luchau:

You said you were in the 400s .

Whitney Lowe:

Yeah, we were in the 400s. It was the kind of thing like we're duct taping the windows and putting blankets in front of the doors and everything and not going outside because it was a really bad.

Til Luchau:

We were very bad here in Colorado too. It's an ongoing and will be ongoing continuing concern.

Todd Hargrove:

Do you guys make the homemade air filters with the box fan and a MERV 13?

Whitney Lowe:

I saw some things like that on the web. I've got some high performance air filters in my office anyway because I have these parrots in there and they put out this dust that's really bad for my respiratory. I've got to have these air filters running most of the time anyway.

Til Luchau:

Parrot dander removers.

Whitney Lowe:

Yeah, exactly.

Til Luchau:

Yeah, maybe we should look for an air filter company to be a podcast sponsor.

Whitney Lowe:

Hey, there you go. Clean your life.

Todd Hargrove:

I'm telling you, box fan, MERV 13 filter, blow the fan through the filter. I did that last summer when we had a lot of smoke. The thing was like brown within what? Two weeks and I was like that would be in my brain right now.

Til Luchau:

That would be in your brain and elsewhere. What's a MERV 13 filter? What is that?

Todd Hargrove:

Well, the air filters have different filtering capacity. So you need to get up to an 11 before you're catching the fine particles from smoke. Some of the filters, the kinds you have in your house are probably like a six or seven because it takes a ton of air pressure to blow through it when it's really dense. But that's also what gets out all the dust particles, the smoke particles.

Til Luchau:

Okay, everybody. This episode was brought to you by Todd Hargrove and his MERV 13. Plan is right off of YouTube. Go check it out.

Whitney Lowe:

There's your side hustle, Todd. Building air filters.

Todd Hargrove:

I can't hustle it because it's so easy to do. Homemade, you get a box fan. 20 bucks. The filter's 10 bucks. Go to Home Depot and get some duct tape and put it together.

Whitney Lowe:

Okay, cool. All right, we'll do it.

Til Luchau:

Well, what else? What else do you want to make sure we touch in on? What are your closing thoughts, that kind of thing, Todd?

Todd Hargrove:

Well, you can find me at toddhargrove.substack.com.

Til Luchau:

All right. There's one takeaway. That's one. It's been fun to talk to you and just hear your take on these things, of course. But again, just to start to get deeper into this idea that everything going on with our clients, it has some sort of story behind it, some sort of mechanism. Even though they're complex, sometimes the ways that people respond to them don't have to be.

Todd Hargrove:

Yeah. Yeah. Simple solutions to complex problems. That's a good phrase, right?

Til Luchau:

Yeah. What do you think Whit?

Whitney Lowe:

All right. Well, that sounds good. Well, I think we can consider it a wrap there for today. Todd, thank you again so much for coming to visit with us today and hang out and jump into some fascinating discussions here and hopefully, we'll do it again sometime down the road as well.

Todd Hargrove:

Thank you very much for having me. I enjoyed it.

Whitney Lowe:

Yeah. I would just like to remind everybody to check out Todd's podcast. It's another great show that's out there. Better Movement is the name of the podcast. That's correct, isn't it, Todd?

Todd Hargrove:

Yes.

Whitney Lowe:

Also put a plug in there for some of these other resources and things that are on the website, because there's some fascinating stuff in there. Make sure you have a chance to look at that stuff. All right, well. We'll wrap it up for the day today.

Whitney Lowe:

We would like to mention also that ABMP is proud to sponsor the Thinking Practitioner Podcast and ABMP membership gives massage therapists and bodyworkers exceptional liability insurance, numerous discounts and great resources to help you thrive. Like their ABMP podcast, which is available at abmp.com/podcast or wherever else you happen to listen.

Til Luchau:

Even if you're not a member, you can get free access to Massage and Bodywork Magazine, where Whitney and I are frequent contributors and special offers for thinking practitioner listeners at abmp.com/thinking.

Whitney Lowe:

So thank you again to all our sponsors. You can stop by our sites for handouts, show notes, transcripts and extras. You can find that over at my site at academyofclinicalmassage.com. Til, where can people find that on yours?

Til Luchau:

Mine, advanced-trainings.com. If there are questions or things you want to hear us talk about, guests you want us to invite, email us at info@thethinkingpractitioner.com or look for us on social media, just under our names. Mine is Til Luchau. What's your name Whitney Lowe?

Whitney Lowe:

Today, my name is Whitney Lowe. You can find me there as well under that. So if you will, also please take some time, rate us on Apple podcast as it does help other people find the show. You can hear us on Spotify, Stitcher, Google Podcasts or wherever else you happen to listen.

Whitney Lowe:

Please do share the Word and do tell a friend. Of course as always, if you're unable to find us in any of those locations, you can tune your teakettle whistle to Concert C and you will hear us in the residual steam off of that.

Whitney Lowe:

Thanks again, everybody, for being with us here. Todd, thank you again. Great to speak with you all and we'll see you again here in a couple weeks.

Todd Hargrove:

Thanks, guys.

Til Luchau:

Steamy, thank you.