Welcome back to the Healing Pain Podcast with Scotty Butcher, PT, PhD
We’re discussing how to build mind-body strength and resilience. My expert guest is Dr. Scotty Butcher. Scotty is a physical therapist and also trained as a respiratory exercise physiologist, a strength and conditioning specialist, and a meditation and mindfulness teacher. He currently teaches and researches the integrative mind-body practices of strength training and mindfulness in healthy individuals, older adults, and those with chronic disease.
On this episode, we discuss the implications of mindfulness for both physical, as well as mental health and well-being. Tips and strategies for improving mind-body strength and resilience, the controversy around Polyvagal theory and how it implies to physical therapist practice. Also, examples of mindfulness in movies and popular culture. Techniques to build mind-body resilience sit well within the scope of physical therapy practice and many other healthcare practitioners.
This is a topic that speaks to our population of not only providers but people who are interested in improving their health and wellbeing, specifically those with chronic pain. It’s a topic that we’ll spend more time on as we evolve in the show specifically. I’ll be looking more into mental health, physical therapy, and how the treatments that we use as physical therapists exercise physical activity, manual therapy, different types of modalities, lifestyle-based interventions, how they can all have an impact, not only on our physical wellbeing but also our mental wellbeing and how we can start to educate.
The communities we interact with, either in our hometowns or broadly social media, public health, and even politics, there’s a place for this with regard to evolving the topic and the conversation around physical and mental wellbeing in PT practice and healthcare in general. Stay tuned for more. If you’re enjoying the show, please make sure to head on over to iTunes, leave us a five-star review, and say something nice about us. It does help us increase awareness about the show and the overall message that it sends. Without further ado, let’s begin, and let’s meet Dr. Scotty Butcher.
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Scotty Butcher, PT, PhD discusses the implications of mindfulness for physical and mental health and wellbeing, sharing bio-hacking tips for mind-body strength.
Scotty, welcome to the show. It’s great to have you on.
Thanks. It’s awesome to be here.
I’m happy that you joined us to talk about mind-body strength and resilience and biohacking and what all that means to you. You’ve studied this on a research level through your PhD a little bit. You’re exploring new research endeavors which I want to hear about and we’ll talk to you about but the word biohacking is used a lot. You see it online. It’s in blog post titles and things like that. What does biohacking mean to you as a physiotherapist and a researcher?
Biohacking for me is any method that you have of self-improvement and resilience-building. This is through personal practices. Those are things that you do in terms of self-care. The key and the cool thing about it is I’m a pretty big nerd. I like technology and integrating tech into it. To me, it’s using the current technology which has boomed in the last few years in terms of what’s available to you. Biohacking can be something as simple as doing basic self-care like mindful practices and doing exercises on a regular basis.
It’s physical activity and strength training in combination with mindful-based practices and sleep, hygiene, and nutrition. You’re big into a lot of those aspects of it as well but then it’s developing a practice that’s intentional to me. That’s the aspect of it. It’s intentionally developing some interception and learning to listen to your body, whether it be through tech-type devices or through listening to what your body is telling you.
I’m doing a lot of things around heart rate variability biofeedback and looking at measuring my resonance frequencies. We could talk about that if that’s not familiar to any of your readers. I’m doing some EEG biofeedback, which is completely out of my realm in terms of professionally. It’s cool to assist mindfulness-based practices. I’m starting to get into doing a lot of exercise-related tracking heart rate variability, heart rate responses, thinking about the applications of Polyvagal theory, and how that relates to exercise responses and in a holistic-integrated type of response. It’s a combination of a lot of that stuff.
I like how you’re bringing the technology in with the research and the practice. There’s a lot of that out there. We have a lot of technology and apps out there, more and more things that can run on your computer or your cell phone. I appreciate people like you start to test the technology because not all of them are great. Some of them are wonderful. Heart rate variability is underutilized in the PT world. I’m glad you’re starting to do a little bit of research in that area. How did you get to this place though, where you’re like, “I started out as a Physio, clinical practice.” You did your PhD. It focuses on strength training is that right?
It was on Exercise Physiology and Respiratory Physiology. It was a combination. It was strength and conditioning but I also had a Respiratory Physiology flavor. I was interested at the time in pulmonary rehab and so rehab for people with COPD. I did a lot of my work in understanding the exercise limitations to individuals with ventilatory limitations. You can’t train centrally when your lungs and the heart are limiting factors. You have to think about training peripherally and what that looks like. That led me down the path of strength training.
Two things brought me into what I’m doing. One’s on the personal side and one’s on the professional side. Personally, I have struggled, dealt with, been present with anxiety and bouts of depression at varying points in time in my life. I’ve come to understand that my anxiety is about developing awareness. This interception is vital to understanding that. Mindfulness and biohacking made a lot of sense in terms of dealing with the issues that I was dealing with, the mental concerns that I was having, and how to recognize what my anxiety was and what it was doing to me physiologically.
On the professional side, I was doing a lot of work in strength training. With older adults, for example, I was hearing things that I wasn’t measuring in terms of my research. I have a lot of physiological and physical measures. I was hearing stories that sounded a lot like resilience to me and things that people were able to do better and cope with challenges better. I wasn’t capturing that through my research. That led me to think about, “How can we capture resilience?”
As part of that, I then came back to the mindfulness aspect with the big relationship between resilience and mindfulness. My personal and professional world all clashed and now they’re all melded into the same thing. The things that I do for research are the things that I’m trialing myself personally. I am a big believer of if you’re going to do something for research, it should be practice-based. I’m being an n-of-1 on myself and then I can translate that to what I do with my research.
We need more n-of-1 case studies, especially in the realm of chronic pain. I appreciate that. You mentioned the word resilience. People hear the word resilience and it almost automatically makes sense to them. Everyone wants to be resilient. A lot of people think of themselves as resilient, even though they may or may not be resilient. How do you define resiliency?
There are tons of different definitions depending on who you talk to and who you read. As a general rule of thumb, it’s the ability to bounce back. Whether that’s a challenge, physical, emotional, mental, spiritual, any aspect of the biopsychosocial spectrum, you could have resilience or less resilience. It is dealing with challenges.
There’s a missing piece in one of Robyne Hanley-Dafoe’s books. She’s a psychologist out of Toronto, Canada. She talks about the idea of being able to do hard things as part of resilience and building capacity. This is where the strength training aspects that I’m involved with, as well as the mental training aspects, can help you build that capacity as well as your ability to bounce back. It’s a combination of those two things.
There’s an interview out there that I read on resiliency. It looks at resiliency interventions for healthcare professionals, an area that I’m interested in. Things like mindfulness, ACT, and traditional CBT has been shown to promote resiliency in healthcare workers and people with various types of mental and physical conditions as well.
One of the challenges I had with that paper when I read it was it puts resiliency in the cognitive bucket. It doesn’t talk about bodily processes. That’s where you’ve done your work and where you continue to do your work. How do you now view the mind and the body versus maybe how you’ve viewed it before, before your training and even your personal experience with resiliency from bodily processes as well as the psychological processes?
I was trained as a physiologist. It’s very much from a physical perspective, from a physiological perspective. I have always felt that I’ve connected with the idea that the mind and body are not separate entities. We are functioning humans for a reason. The mind-body dualism that started back in the days of “Therefore I am” René Descartes is false dichotomy. It’s one that we’ve created to try and understand these things.
One of my weird courses in my undergrad university degree was on the psychology of the mind. It’s one of those things that I took as an interest before I did my PT degree. I wrote a paper on the mind-body connection. I can’t, for the life of me, find it because we’re talking about 30 years ago almost. I’d love to read what I wrote back then.
The reason I connect with this is that I have felt that the mind and the body being so integrated. That interception that you get with knowing what your heart rate feels like when you’re doing things, when you’re exercising, when you’re anxious, or when you’re under some degrees of stress. I have tried to develop that in terms of myself and that’s right from being a teenager. I’m a huge Star Wars fan as you can tell if you can see my background. If you can’t, it’s full of Star Wars stuff.
For me, the Force is much like mindfulness and the whole concept of mind-body. There are so many Star Wars parallels in this. I can go into that for days. I don’t think that there should be a dualism. The whole basis for biopsychosocial practice doesn’t include spiritual and some other aspects of being a whole human unnecessarily. We need to think of people as whole humans. Being trained primarily as a physiologist, being able to come back to some of those beliefs has been eye-opening. It’s been a huge learning curve because other than that one course, I don’t have a lot of Psychology in my basic training.
That line, “Therefore I am,” has been rephrased, “As I feel, therefore I am,” which would bring in all the interoceptor processes that you’re talking about.
It is all integrated. Mind is not just thinking. The mind is a feeling brain. It’s an emotional brain.
Everything that happens in our body is processed. It goes up and then it gets filtered. Oftentimes helping people be aware of those interoceptor processes helps them with emotion regulation. It helps them with cognitive reappraisal, dealing with their thoughts, or reframing their thoughts if you will. We think that it starts with the mind, cognition, or thoughts, but oftentimes it starts in the body.
It’s interesting because then it places us as physical therapists, squarely in not only the body aspect of mind-body medicine but also the mind aspect of mind-body medicine, instead of keeping us separate. Physios work with the body. Mental health providers work with the mind. That is potentially harmful for patients but I also know that it keeps us siloed and boxed into areas. Your work is starting to piece all that together, which is great.
Thank you. I agree. This idea is interesting. I’m open that I still see a therapist and a counselor for my mental health. That’s an important aspect. It’s like going to train, exercise, and having a coach. It doesn’t mean something’s bad or wrong or it’s negative. It’s a positive thing. It’s interesting because we talk about this all the time. Our worlds are colliding. I talk about the work that I’m doing in the physical realm.
You could look at it as a bottom-up type processing that it’s coming somatically from the body, influencing our thoughts and our emotions. Coming from the psychology side is also recognized in the opposite. It would be interesting because we’ve had some theoretical discussions about what cognitive or emotional therapy and physical therapy look like years from now. They may be the same profession. That would be to our huge benefit and to the benefit of our clients if we can develop that melding of what we do.
I would love to think about that and see those two come together, which they already are in some ways. We’ve got a little bit of a way to go. I love Star Wars by the way. Yoda is set in your right shoulder there. Tell me how has Yoda informed your view of mindfulness?
It’s so cool. There’s so much in Star Wars and the Force that resonates in terms of mindfulness. One of the key connections is the concept of awareness. When we define mindfulness, it is about purposeful awareness without judgment. The way that Yoda as a Jedi Master will teach his Padawans, his learners, for those who don’t speak Star Wars, it’s about developing awareness. There’s lots of quotes and I’ve caught a few that are fantastic to illustrate this.
One of the more common ones that we hear is, “Fear is the path to the dark side.” Fear, being a negative emotion that might be associated with the lack of present moment awareness, potentially, if it’s something that doesn’t involve a present moment focus. Fear is the path of the dark side. Fear leads to anger, anger leads to hate, and hate leads to suffering. To me, how you become dysregulated emotionally and physiologically is through that line of thinking.
The way to come out of that is to not be fearful, be nonjudgmental, and be aware of what’s going on. Here’s another one. You must unlearn what you have learned. You will know good from bad when you are calm, peace, passive. That’s another one of Yoda’s quotes. It’s recognizing that if you are present in the present moment, able to introcept and recognize what you are experiencing at this moment that isn’t ruminating thoughts. It isn’t thinking to the future. It’s that present moment that’s calm, at peace, that passive, that can help you discern what’s right, what’s wrong, and where things should be.
Here’s another one that resonated with me and my personal journey. Yoda talks to Force Ghost Ben Kenobi in The Empire Strikes Back and he says that all his life, he has looked away to the future, to the horizon. I’m going to do a terrible Yoda impression. “Never in his mind was wherever he was. What was he doing?” He is saying that Luke was not able to be present. He was always looking to the future, trying to improve, trying to change, and never recognized where he was.
There are so many more examples of how this concept threads throughout all of the mythos of Star Wars, the movies, the books, all of the things. The last one I’ll mention is Qui-Gon from The Phantom Menace, episode one of the prequels, “Your focus determines your reality.” I love that concept. If you’re focusing on something external, you’re not able to focus on the reality of what is present. This has so many applications, not just for mindfulness but for mindful practices in physio, pain management, exercise, training, in any aspect of life that we think of. I could go on forever but I’m not going to. I’ll stop with those for now.
I was born in the ’70s and raised in the ’80s. I had Star Wars figures growing up as a kid and played with them. I wish I still had those figures because they’re worth a whole lot of money. I had a whole room full of them. I love the quotes you have. Practitioners always ask me, “How do I use mindfulness with guys? How do I use mindfulness for children?”
Some of the things that you’re doing here in a direct and maybe indirect way is you’re making mindfulness approachable. You’re taking something from real life. Someone made this movie. We all know the movie. There’s a context there that we can relate to. You take these characters and say, “Here’s how these characters think. Luke, with his present moments, focus how he used that to fight the bad guys or become stronger.” We need to do that more in our practice with patients.
We’re good at the delivery of things. We’re good at explaining the science. What I appreciate about, not only your personal story but then relating to something that you enjoy, you can relate to and then help us relate to. It is important. Mindfulness is new in PT. I wrote a paper that came out in PTJ on mindfulness and acceptance-based approaches. That was published here in late March 2022. It’s still new in our profession. Should it be something that we are adopting more? It’s not just in pain. Do you see other applications throughout the other physical therapy specialties?
Kudos on that paper though. I did read it and it’s fantastic. It’s a great paper. Short answer is yes. As part of my university job, I teach in a Physical Therapy program. I have an advanced couple of different exercise prescription courses. I have an advanced one that used to be much based on biomechanics, exercise technique, and advanced applications around periodization and things that were strength and conditioning-focused.
In the last few years, I’ve recognized how unimportant some of those things are compared with the ability to connect with a client and to have the client learn how to connect with their own self, mind, body, emotions, and physiology. That doesn’t happen through knowing the right reps and sets or knowing whether you should have a perfectly neutral lumbar spine when you’re deadlifting or allowing some flex.
Things like that are small fishes in the pond. Whereas the psychologically informed practices are the big fishes in the pond. They’re the ones that are going to be the biggest targets. For us as physical therapists, we have an involvement in mental health. Pain management is a part of what we do and mindfulness is huge in those areas. I do think it’s teaching clients and learning how to teach clients how to develop this introception and understand how they can, from both a bottom-up body somatic-focused perspective but also a top-down mental focused perspective, look at the integrative self and say, “What does that mean for me?”
Let’s say an example of exercise recovery. There’s some good evidence to suggest that most psychological and physiological stress reduces adaptations. When I was a brand new PT, if you would’ve told me I could do mindfulness and meditate to improve my exercise abilities and recovery, I would’ve probably laughed and said, “There’s no way.” As much as I was into it, I didn’t see the relevance at that point in time. Now there’s so much evidence that that level of stress can play a part in our adaptations. Those that are under psychological stress don’t have the same type of gains in strength and power.
If you would’ve told me that years ago, I would’ve went, “Maybe as a stressed student or new practitioner, I should pay attention to this.” In terms of exercise recovery, that’s big. The whole idea around chronic and systemic inflammation from a physiological perspective is something that underpins so much of our health concerns, particularly in chronic health, even acute health. How that relates to autonomic system and the autonomic dysfunctions that we can see out there is massive.
Based on what we’re seeing, there are huge applications across inflammatory-type diseases. We do know that the quality of life can improve in those types of diseases. There is a little bit of physical evidence that mindfulness-based approaches can have a physical impact on things like glucose tolerance and insulin regulation, as well as these things around autonomic regulation that we can measure with heart rate variability as an example.
I agree that we’ve got this tech. Something like heart rate variability is so accessible now. It could be something that easily translates into what we do as physical therapists. We could look at individuals in the right state to be able to tolerate, handle, work with, or excel at whatever we’re trying to get them to do. Whether it be work with pain, their mental health, or some physical ailments. Even getting into painful stretching or mindful movements that can get people out of a fight or flight zone. Knowing if that’s where they’re at, some concrete measures have shown well in the research to have some big benefits. Those are the type of things where this concept of mindfulness can have a tangible impact.
I picked up something important that you said. The mind-body or the brain-body connection is bidirectional connection. It’s not just mind-body or body-mind. It is bidirectional, training that for most resilience. Training that also promotes adaptation or adaptability. I love that resilience plus adaptation in some way probably equals well-being or health and well-being.
Especially when you look at it from a biopsychosocial perspective and not the mental side or the physical side, for sure.
In my mind, I try to piece together equations. If I want to promote someone’s well-being or their health then I have to train them to be resilient and to be adaptable. That happens both in the body, as well as the mind. The other thing that you mentioned is heart rate variability and using it in PT practice. Most PTs don’t use that in practice. Can we use that, in our evaluation as a baseline? Is that one of the biohacking practices that you use personally? What other ones can we use in practice that you use?
Heart rate variability is one that I’ve focused on in my personal practice and my research as well. The answer is yes. There are so many ways. I’m wearing an Oura Ring, not that I’m promoting any particular product whatsoever. I have no conflicts of interest when it comes to those things but I love my Oura Ring for sleep quality, recovery, and the good metrics around sleep, as well as being able to track your heart rate variability. It’s not enough to have a good heart rate monitor because they’ll track heart rate but they don’t look at the specific R to R interval between beats and to measure that time. That’s what you need to be able to do heart rate variability.
The Oura Ring is able to do that. It tracks your R to R intervals. It can give you a sense of when your variability increases or decreases. There’s way more to it than an increase in heart rate variability. There’s not one marker and measure of heart rate variability. There’s many of them but I like it from that perspective. The activity monitor in here is good for sleep quality as well. You combine that with temperature changes that it measures and the heart rate variability. It’s a nice marker of recovery and sleep quality.
I’m starting to use it to guide my training practices. It’s mostly on endurance training. A couple of papers in CrossFit have come out. They found out that if you train hard on a day where your recovery and your heart rate variability are low, you don’t adapt as well as if you guide your training based on heart rate variability.
On the days that you have a bad recovery day or a heart rate variability day where it’s low, if you titrate your training downwards and say, “I’m either going to reduce the intensity or the duration.” It doesn’t have a negative impact, first of all, on your training ability, it makes your training more efficient. You can have potentially better improvement with better recovery with less overall physiological stress.” There’s some decent evidence around that. There are lots of other ways to do it too.
I do heart rate variability biofeedback. Now that the Oura Ring doesn’t do that, I need some other measures. I have a Polar H10 Heart Rate Strap. This is the one that will record the R to R intervals or one of the better ones. I’ve also got a CorSense from Elite HRV. Elite HRV is another one of the apps that you can use a finger clip-like oxygen sensor but it senses the pulse. You can modify your heart rate variability by changing the frequency and the depth of breathing. It’s fairly straightforward practice.
I’m talking about all this cool tech but there are apps out there that you don’t even need a lot of tech. You can use your smartphone camera and light that will detect that. The validity on those is a little bit less and it’s improving more as the apps are developed. There are lots of cool ways that you could easily integrate that. Heart rate monitors are not that expensive, even the good quality ones. Having a few available in the clinic that can do this and pair them up with a device, it’s easy to measure.
If you were to do even a 2 to 5-minute resting baseline, maybe not the first day of an assessment, but in the beginning, and then have people track that over time. Maybe each time they come into the clinic, they start by doing something like that. You get a sense of where they are from an emotional and a physiological autonomic regulation perspective that can help you potentially titrate up or titrate down based on what you’re seeing.
It brings a lot of value to a PT practice as well. Bringing technology in that could help someone understand their psychological and physiological processes. Us, as the professional, is the bridge there that helps people understand what all that data means. We do have the apps and these ways to bio-track lots of different things. Sometimes we start to read the data and the reports. It’s a little confusing for someone if you don’t have a Physiology background like yourself or a PT background like we have.
The health literacy is pretty low out there. In the heart rate variability, people get the heart part and all the rest of it is, “I’m not sure what that means.” I like that you can bring technology and it can add high value quality care to someone’s episode of care. Along those lines of introception, heart rate variability, Polyvagal theory is something that interests you. You’re starting to do some research in there. Can you give us a little insight about the things you’re interested in that area?
I’ve been fortunate. I stumbled upon Polyvagal theory as part of my personal work. Since then I’ve met some of the people that are involved in that. I’m working on a paper with Stephen Porges and Marlysa Sullivan. We’re looking at the applications of Polyvagal theory in PT. If you’re not familiar, Polyvagal theory is you’ve got two streams of your vagus nerve that are involved with the parasympathetic nervous system.
One’s the dorsal, one’s the ventral. The dorsal vagus complex is the one that’s more on the shutdown side. When we think of the parasympathetic system of having things shut down and freeze, it’s more involved with that whereas the ventral vagal system is more involved with social engagement. It’s the one that if you can ramp up that ventral vagal complex through things like breath work and mindfulness, that can impact your ability to feel safe in your environment. That’s the underlying psychological side of things.
Physiologically that means that has an impact on your heart rate variability. When you are more socially engaged, you have a higher heart rate variability when you’re at rest. Because I’m a strength training guy, that’s my passion. The interesting part for me is about the balance between running up and running down the systems and saying, “We’re so much focused in our daily lives that training people to have a good vagal break and having the vagus nerve through the ventral vagal complex, to be able to be on when it needs to be on.”
We also need to know how to take it off. It’s not enough to say, “We’re all in the sympathetic state. We need to be parasympathetic.” We need to train individuals to be sympathetic as well. A good example of this is low back pain. In low back pain, there’s tons of muscle rigidity. One of the studies that I did for my Master’s was on core stability. I hear now, “Don’t do core stability because it’s going to increase rigidity.”
I completely disagree with that because core stability isn’t about developing stability. Even though we use the word stability, to me, it’s about teaching the body in the presence of pain to be able to turn those muscles on when needed and turn them back off again immediately. It’s that balance and that jumping from sympathetic to parasympathetic in a regulated state that we can control autonomically. Our body knows how to do that. That’s one of the huge missing pieces. The Polyvagal theory stuff is engaging and intriguing to be able to think about. Our system is so applicable to PT.
Turning on and off, there’s that adaptability there again. I have the awareness that I know how to modulate my own neuromuscular system. I’m on the same page. There’s so much about how to quiet the nervous system, how to turn the nervous system down, how to decrease the sense of nervous system. I’m like, “People, we need our nervous system to be online.” The point of our nervous system is to monitor everything that’s happening inside and outside of the body and then process that.
It’s under our conscious control to decide how we want to respond to that. They bring a little bit of mindfulness in there with the conscious piece of it but I’m on board with you. Don’t throw out the bathwater with regard to core stabilization. There’s something important there for people who have low back pain and other chronic health conditions. Congratulations on collaborating with Stephen Porges and Marlysa Sullivan. Stephen Porges is the founder of the theory. He’ll have a lot to contribute. Marlysa has done some work in Polyvagal theory before she’s been on the podcast as well. Do you think the PT world is ready for that theory yet?
Polyvagal theory is mostly controversial because there hasn’t been shown to be an anatomical distinction between both the dorsal and the ventral vagal complexes. If people are going to get caught up, it’s that they can’t see a mechanism directly and the research hasn’t shown that. The application from a clinical perspective, both psychological and physiological sides is too hard to ignore. Whether we’re ready or not, it depends so much on your focus and how much information we can get out, like the articles that you’ve written and the ones that I’m working on. There will be more information over time. Whether we’re ready or not, it’s coming.
It fits well into PT as far as I’m concerned. I know you feel the same way. We’ll look out for that paper when it publishes. I would love to have you, Marlysa, and even Steven on to talk about that. In the meantime, Scott, it’s been great chatting with you. Let our readers know how they can follow you and learn more about your work.
I want to thank Dr. Scotty Butcher again for being with us on the show, talking about biohacking for mind-body strength and resilience. You can follow all his work by following him on his various handles @TheStrengthJedi.com. If you’re following along with us, take a screenshot on your phone and tag us on Instagram at DrJoeTatta.com and at TheStrengthJedi.com. We’ll be sure to tag you back. Thanks for joining us and we’ll see you next time.
- Dr. Scotty Butcher
- Dr. Joe Tatta’s article on PTJ
- Oura Ring
- Polar H10 Heart Rate Strap
- Stephen Porges
- Marlysa Sullivan
- Instagram – The Strength Jedi
- Twitter – The Strength Jedi
- Facebook – The Strength Jedi
- Instagram – Dr. Joe Tatta
About Scotty Butcher
Dr. Butcher has been trained as a physical therapist, a respiratory exercise physiologist, a strength and conditioning specialist, and a meditation and mindfulness teacher. Scotty teaches and conducts research on the integrative mind-body practices of strength training and mindfulness in healthy individuals, older adults, and chronic disease population. In addition to his academic work, Scotty is Jedi Master to three Padawan cats and 5 young Jedi Knights, and the husband of a Rebellion General.