Welcome back to the Healing Pain Podcast with Dr. Karen Litzy, PT, DPT

It’s a pleasure to be spending this time with you. Speaking of time, we have a long episode. This is probably one of the longest episodes since I began the show a few years ago. The reason why is because the topic of forgiveness is an important topic for those living with chronic pain. It’s also the first time that we are broaching this topic. I figure we take a nice deep dive into the science behind forgiveness, how it affects both cognitive behavior and motivational components and bring a human voice and experience to forgiveness and chronic pain. The definition of forgiveness is the act of willfully putting aside feelings of resentment toward an individual or an event that has committed a wrong, unfair, hurtful, or otherwise harmed you in some way.

Forgiveness is not equated with reconciliation or excusing someone and it is not merely accepting what happened or ceasing to be angry. Rather, forgiveness is the transformation of one’s feelings, attitudes and behavior so that you’re no longer dominated by resentment and can go on living the life you’d like to live. Forgiveness is often identified as an important part of life and it can also be an important part of pain rehabilitation. Here to speak to us about forgiveness is Dr. Karen Litzy. She’s a licensed physical therapist, international speaker, host of the Healthy Wealthy & Smart podcast and owner of Karen Litzy Physical Therapy.

Through her work as a physical therapist, she has helped thousands of people overcome painful conditions, recover from surgery and return to their lives with family and friends. She has been a featured speaker at both national as well as international events, including the International Olympic Committee Injury Prevention Conference. In this episode, Karen shares her own story about developing pain, coping with pain, overcoming pain, and the role of forgiveness played in her recovery. I want to thank Karen for joining us to speak about this important topic and especially for her openness, honesty, and authenticity on the topic of forgiveness and chronic pain. Let’s welcome Karen to the show and learn about forgiveness and chronic pain.

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Forgiveness And Chronic Pain With Dr. Karen Litzy, PT, DPT

Karen Litzy, welcome to the show.

Thank you for having me, Joe. I’m excited to talk with you.

First, you and I need to dip our toe or maybe go full underwater and talk about a topic that I don’t know. Is anyone talking about this in the world to physical therapy?

I don’t know. I’ve had conversations with Adriaan Louw and Kory Zimney about this because I spoke at the Align Conference talking about my journey, my history with chronic neck pain. I asked them about the concept of forgiveness, which is what we’ll be talking about. The concept of forgiveness, not around me forgiving the people around me or asking the people around me for forgiveness. Maybe I was cranky or I didn’t want to hang out or was maybe not the best friend or daughter, a sister at the time. Thinking more about forgiveness as can you and should you as the person living with chronic pain forgive your body for betraying you. It’s different than saying, “I forgive myself for making that stupid mistake,” or “I forgive myself for not going to the gym.” You forgive this thing that may be at the time you felt like you didn’t have a lot of control over. How does that play into the role of recovery from chronic pain?

I thought about this after watching a TED Talk at TEDx Lincoln Square. The woman spoke about forgiveness and what does forgiveness means. In her case, it was forgiving the young man that murdered her family. She described carrying around this weight that was clamped at her side ever since that happened. Do you forgive because you’re a good person and good people are expected to forgive? Do you forgive because it’s the right thing to do and good people are expected to do the right thing? Do you forgive because you’ve come to that place in your life where you can’t carry everything around with you? It got me thinking in the context of chronic pain, people living with chronic pain, is that something that helps you let go or detach yourself from that baggage that you’re constantly carrying around with you? Those are my thoughts. I don’t know if there’s a lot of chatter about that in the PT world. There’s some scant research here and there. You probably can talk a little bit more about the research. That’s where I’m at. We started talking about this and thought, “This might be good to put on a blog.”

There’s not a whole lot of research in the physical therapy literature. When I wrote my book a couple of years ago, I was thinking about different topics and reflecting back on all the various practice environments that I’ve worked on. Early on, I worked with spinal cord injured patients and many of them were involved in horrific accidents to no fault of their own. Some of them were shot as passengers walking by on the street. Some of them were in accidents. I thought back to them. Not only is a lot to go through an inpatient rehab experience and rehabilitate from a spinal cord injury, but when you don’t expect something like that, there are a lot of emotions that come up and become part of that experience. We’ve talked about it before. For you to talk about your pain experience and how that began, what it looked like and how it colored your life.

I first had neck pain many years ago. I’m going in my head. How long have I been in my apartment? It wasn’t my second apartment. This was my first apartment when I moved to New York. I don’t know if like a lot of New Yorkers get their timelines by where they live. I knew it was within the first five years that I moved to New York City. I was maybe 31. I had no problems, no preexisting conditions, no other, “I felt a little bit of neck pain here and there throughout my life.” That was not the case. I woke up one morning and couldn’t move. I couldn’t get out of bed. Even the slightest of turning my head, even turning my eyes hurt.

I’m trying to roll over, trying to get up. The pain was like something I never experienced, neck pain. It was painful that I couldn’t even yell to my roommate to help me get out of bed. She was a nurse so it would have been perfect. It was that bad. I didn’t know what to do. Finally, I rolled out of bed, flopped onto the floor. When I stood up it, it felt like a cervical collar. It felt like my head was a big gigantic bowling ball on a toothpick. I had no control over it whatsoever. I thought, “What am I going to do?” Because I’m a physical therapist, I’ll go to work. I’ll see if someone there can take a look at it, let me know what’s going on.

Do I look back on that and say, “Maybe I should have gone to the emergency room?” I don’t know. What would they have done in the emergency room? They probably give me painkillers. I wrapped my hands around my neck. I got into a taxi and I went to work. That started it. It lasted about 8 or 9 years having pain every day, varying degrees. Sometimes it was better, sometimes it was worse, but it’s always there. There was never a day that I was like, “I feel good.” I don’t have any pain at all. It might’ve been a 1, 2, 3 versus an 8, 9, 10, but it was always there. I resigned myself to the fact of, “This is it. I’m going to live with this. It’s not that bad.”

You’re a physical therapist. You’ve been healthy, vital, exercising, and loving life. You have an episode of pain, intense, doesn’t go away last nine years and all the while you’re still going to work. Your primary focus all day long, 8 to 10 hours a day, is helping other people.

I gave a talk about my pain. Someone in the audience asked me when your patients came in and they said, “We have pain.” You ask them, “How would you rate it?” They said, “Four and I can’t even do this. I can’t do that.” “Did you think to yourself, three? I met an eight and I’m treating you. What do you mean you can’t do X, Y, and Z?” It is an interesting point to bring up. My answer to that is I’m human. I’m sure I did think that. Maybe that did give me a little bit of bias towards patients that came in, but ultimately it gave me more compassion for people when they come in and their pain is whatever it is because whatever their pain is their pain. I have learned through having my own pain experience that it is not my job as a PT to judge a person’s pain. It is our job to listen to that person and to get a better understanding of their pain without judgment.

Did you have days where you didn’t go to work or you went to work less? The reason why I’m thinking about that is that as I listened to you talk, it’s like there are two sides of the same coin. On one side, you love your work, you find a lot of value in your work. Starts talking about values, act and how you can still do things that you highly value even though you’re experiencing pain. On the other side of the coin, I think about not physical therapists, all the licensed health practitioners that are under a tremendous amount of stress and the high burnout levels we have. Are we being compassionate enough with ourselves when we need to be cared for?

I would say I probably was not. There were certainly days where I went into work and my two bosses, Mike and Stewart, are like, “No, we’ll take care of your patients, you need to go home.” I always went to work. There were some days where I wake up and I couldn’t get out of bed so I’d have to call out. That was far and few between. I will also say that during this time, I was still playing softball in the summer almost every Saturday. Even though I had this pain, I was still able to play softball and I was a windmill pitcher. I was pitching, which you would think, “How can you do that if you’re in so much pain?” I did it because I enjoyed it. I’ve been doing it my whole life. It wasn’t a threat to the system for me. For me, it was the opposite of the threat. It was a SIM, not a DIM.

It’s a sign of safety. How’d you start to unwind this conundrum you’re in?

I would say it all changed. I started to unwind when I went to see David Butler speak at an APTA event in Washington DC. My friend, who you also know, Erica Mellow, said, “You got to go see this guy, David Butler, who’s great.” At the time, I didn’t know who he was. I was a PT. We talk about that lag of 15 to 17 years of initial research before it gets the treating clinician. Lorimer Moseley’s work, David Butler, in particular, his work on pain was first published like 1996 or 1997. I met David Butler several years after that came out. I met him in 2011, so talk about that gap in research. I’m in the bids. I went to go and see him. He was talking about pain and things that can contribute to your pain and the concepts of fear avoidance. I sat there with tears rolling down my eyes because I was like, “Finally, someone is talking about everything that I’m experiencing.” I do have a fear of avoidance behaviors. I do have more pain on days when I’m stressed.

Finally, I was like, “It’s not me.” All this time, I thought, and we can say a lot of our patients probably feel this way as well, is they’re constantly doing something to themselves. That’s why they always have the pain or that’s why they have a flare-up or that’s why the pain is worse one day than the other. “I must have done something.” How many times have you heard a patient say that? Countless times, “I must have done something. I don’t know what it is.” That’s what I was feeling all the time was, “It must have been because I was carrying too much,” or “It must’ve been because I sat on this bus for 3 hours,” who knows? Once I heard him speak, I asked him to come onto my podcast and he said, “Yes.” It turns out he was going to be in New York. He came where I worked and sat with myself and with Stewart for 2 hours.

Thousands of people are now like, “How did all that happen? I can’t even get David Butler to respond to an email because he’s so popular.”

He helped mentor me and help get me on a program. He was like my distance PT. I would say after speaking with him and diving into a lot of the research, reading explained pain, reading painful yards, reading the research, looking into neurodynamics and things like that. Within 3 or 4 months, my pain was half of what it was. There are days I was waking up without pain. I should also add that at this time, I was taking Pilates with an excellent Pilates instructor who raided my program up. I was working with a life coach. She was helping me unravel some other things and my feelings about pain and what that meant. It wasn’t just, “I went to see David Butler.” Three months later, I was better.

I went to see him. I dove into the research. I had a better understanding of what pain is and how it was affecting me. I started going to the gym and doing things again because I had stopped everything. My whole thing was I couldn’t carry anything that’s going to hurt my neck. In New York City, you have to carry things. I started little by little adding graded exposure to the activities that I would avoid. All of that combined together and it took three months to feel about halfway better and probably like maybe 8 or 9 months to wake up almost every day without pain.

You and I spoke about this conversation a little bit. It brings up this topic. Explain Pain created by David and Lorimer. I recommend their work all the time on this show. Everyone should buy Explain Pain. If you’re a practitioner, Explain Pain Supercharged, which is a little bit more science. You and I had the conversation of the reconceptualization of pain, which is the theory behind how it works and that sometimes there’s a partial reconceptualization of pain. Meaning that people don’t fully reconceptualize, they don’t get to the point where all of us hope and necessarily strive for. You mentioned within four months you had 50% less pain. This may be difficult for you to think back and reflect upon, but looking back now, did you notice that as you were reconceptualizing pain, that there was a one-to-one correlation almost of your pain decreasing? That’s what we hope for.

I would say yes to that as I was reconceptualizing the idea of pain. It’s a practice. You have to practice reconceptualizing that every single day.

You’re saying as a licensed physical therapist, it took you four months to process all of that.

Sometimes I still process it. When I have a flare-up, I wake up. I’m like, “What did I do yesterday?” I’m like, “It’s a flare-up. Don’t freak out. Let’s get to the gym. Let’s get moving. Let’s add some sims to the pot if we can and see if it can spill over with SIMs instead of DIM, Safeties In Me versus Dangers In Me.” It might mean, “I’m going to do an extra meditation maybe so that I can help calm down my nervous system” or for me, sometimes I like to crochet. Reconceptualizing for me doesn’t mean I’m making anything, but I’m going to get my hands moving again. When it comes to reconceptualizing your pain, like pain itself, you can put a lot of inputs into that reconceptualization process.

I don’t think there’s anyone right or wrong. It depends on what works for you as the individual. For me, it’s an ongoing practice. I’ve been fairly pain-free for maybe four or five years, but it’s still an ongoing practice. I had a flare-up like my hand isn’t as good as it could be because I do have some radicular symptoms that run down into my hand. My right-hand feels great and my left hand is a little shaky. It’s not opening as much as I would like it to. In the past, I would have freaked out and stayed in bed all day.

One of my big reconceptualization is that I can still move and I can still do things in spite of the fact that I’ve got some symptoms down into my arm or my neck has been a little stiff for the past couple of days. I can also look back on the last couple of weeks and say, “Things were a little bit more stressful.” I did take two months off of the gym. I don’t like to admit it, but I did. I feel that difference when I’m not lifting weights and being active. That’s a good correlation for me. It’s a good reason for it to push me to the gym.

I want to rewind the wheel a little bit and go back to what you said about “People coming to us and even yourself noticing, I did something this weekend, I don’t know what it was and now I have more pain.” Along the theme of forgiveness, there’s a sprinkling of guilt that occurs there for people where when you’re caught in this loop and constantly, “What did I do this day? What did I do yesterday? Did I do the day before? What did I do this morning? How I slept and how I ate?” If you’re “responsible” for yourself and that’s the approach you take, does guilt have a through-line there?

I used to joke about it and say, “I grew up Catholic, so they pile on the guilt.” I am Italian. It’s like double trouble. All joking aside, those feelings of guilt that you did something to yourself certainly underlies a lot of that. That’s where when I was working with my life coach, Laurie Fields, that was something that we worked on. It is like saying, “You didn’t do anything to yourself.” It’s this biological process that’s happening. I went on a roller coaster or was in a car accident that’s a little bit different. I had a fall or something. Living everyday life, I had to get over the fact that I was guilty of living.

If you’re stuck in this cycle of guilt because you’re living your life, it’s going to be hard to get out of a painful state. That was something that we did work on and did specifically address. You have to be more compassionate with yourself because if you can’t have it for yourself, you’re not going to have it for anybody else. Learning how to be a compassionate self-person. It’s not being selfish. You get into, “If I’m only thinking about myself,” it’s selfish, which is another form of guilt. It’s hard to break out of that and to allow yourself the space to live your life and know that you’re not always sabotaging it.

There are two ways that may help people with that. One way is asking yourself, “If a friend came to me who was in this type of condition, what would you do for them? How would you respond?” To look at yourself in that perspective. There’s another more technical, the observer perspective, learning like if you were a fly on the wall, observing yourself, what do you need? What are you yearning for? Some of that helps people identify, “I don’t need to be hard on myself. This isn’t my fault. Let me nurture myself a little bit through this process.”

That’s a healthy coping mechanism and strategy for overcoming chronic pain and dealing with all the sequala of that. It’s not the pain, never the pain. Although you and I spoke about this briefly, I don’t want to go off on a tangent, but there are still entire websites and we’ll call them physical therapists and other practitioners, who are looking at the body from a mechanistic perspective. Even people who look at chronic pain from pain mechanisms boils things down to a place that’s not useful at times for people. Were there people that you had to forgive through this process?

People that I had to forgive them, like if they had wronged me in some way?

I had this one patient who stands out in my mind who I was treating her for osteoarthritis conservatively. She didn’t want to have a knee replacement, so she winds up going in for a debridement, which is a relatively simple procedure. Although the one main side effect of any invasive procedure is an infection. She had a raging staph infection that made her knee pain worse as well as other things. She was pissed at, “The doctor said this would be easy. They said I’d be walking out the next day.” She did walk out the next day. It’s just the day after that. The infection takes rue and they are great health challenges with that. She was angry. She’s clear about it. Like, “I’m pissed at this physician.” Even though we know that infection is a hard thing to keep at bay in the hospital. That’s an example that sticks out in my mind.

My answer is no. I don’t think I was wronged in any way. I don’t feel like any of the care that I got during this time. Name it. I went there, yoga, Pilates, personal trainers. My regular physician, orthopedics, pain management, physical therapists, acupuncturists. Nothing never made me significantly worse. One thing made me significantly better, but I always felt that regardless of my outcome that they had my best interests at heart in their treatment plans. I didn’t feel like I was getting swindled or it was a snake oil salesman or anything like that. I don’t think that I felt like I would have to forgive anyone for the state that I was in. That goes to friends and family as well. Everybody was kind and compassionate toward me, which looking back on it, I was lucky.

As a physical therapist, you don’t look back and say, “I don’t understand why the school didn’t teach me about the neurobiology of pain,” and bring that forward into how that affected your experience.

I was angry that it took so long for the research to get to me and for this the right treatment plan to get to me. I don’t think I was angry at any of the people that I had seen who was giving me the best that they knew at the time. Eric Kruger, he got his PhD in Psychology and ACT. He had once said to me and this might’ve been at CSM, “Do you feel like you made the best decisions you could have made at the time given the information that you had available to you?” In looking at it that way, I would have to say my answer is yes. That I feel like I did make the best decisions at the time, given the information available to me. It’s that now I have a lot more information available to me. I would have made different decisions if I had the information that I have now, but I didn’t. It’s a moot point. I can’t look back and feel regret about what I did because I felt like I was doing the best for myself at the time with the information I had available.

At what point did you start to make connections to some of these unpleasant emotions that I’m holding on to may be affecting my health? Not necessarily with relation to pain itself, but maybe with relation to other aspects of health? When you look at the research, before people get to the point of forgiveness, there’s a lot of information around guilt, fear, anger, and resentment and all of that is a stress on the body and the mind. The mind is the body or the brain is the body. Making those connections to release this slowly but surely. It may be adversely affecting my sleep or the way I’m eating or other aspects of health.

This whole concept of forgiveness for me is new. I would say it’s within 1.5 years where I’ve been looking at forgiveness as a way for me to let go of that guilt and fear that maybe still has a little clamp at my side that I have to drag through Manhattan every day up, down subway steps and whatnot. For me, the biggest was probably resentment of a waste of ten years of my good solid 30s. That’s where the forgiveness came from. Can I forgive my body for taking that away from me? Whereas all of my other friends were getting married, having children, starting their lives and I was stuck in this pain cyclone clone that never let up. Looking at where I am now versus maybe where I was a decade ago, we want to do the 2020 thing. I was probably still heavily having some pain and couldn’t even think about being in a relationship because I thought, “Who would want to be in a relationship with someone who’s such a burden?” That was probably one of the hardest things to do.

We notice that as I was reflecting on your experience, which you gracefully sharing with us that we can now reflect that back on our patients who don’t have the knowledge we have, don’t have the facility we have and don’t have access to the information. Even once they access the information, they have to figure out, “How do I process this now?” This book, Explain Pain, is a beautiful book, but how do I start to process that, connected to relationships, work and my self-care in life? There are such important topics and I’m happy that we’re talking about them.

With regard to unpleasant emotions, we’ll call them on our health. We know that it stimulates the HPA Axis, which promotes stress hormones. Stress hormones can impact many systems of your body, your cardiovascular system, your immune system, your digestive system, sleep, your sex drive, all of those things. When you start to look at how do I start to unpack all of these negative emotions and why should I do that? Why should I visit a place that’s unpleasant and painful for me, both physically and emotionally? That may be the window to a whole new life by doing that.

That’s would I hit the past year. Part of it was I joined a speaking group because I knew I was asked to give a talk about my experience with pain in another lens. I said, “I better join this group because I don’t want to screw this up.” I might’ve said the F word. I went out on stage for my first day of speaking class and started talking about my experience with pain in the third person. Looking at it like, “Did you ever have a patient come in that’s so and so?” The head of the speaking group, her name is Tricia Brooke. She was like, “I have a question. Is this about you?” I was like, “Yes, because at the end, the twist was going to be like, would you be surprised to know it’s me?”

She’s like, “If it’s about you, why don’t you start it about you? What’s the problem here?” I was like, “I can try.” We reworded some things. I started to talk about it and talk for maybe 5 minutes and broke down in tears and couldn’t get through the rest because I had never spoken out loud about how this pain affected me. The next week I got through a little bit more and then would cry. Finally, I was able to get through the whole thing without crying, maybe having to take a pause here and there. I remember at the end of our last showcase, the woman was like, “It’s such a great source, but you should keep in the crying part.” I was like, “I wasn’t doing it purposefully. I couldn’t get through it.”

Being able to open up and talk about, because part of that talk was about the fear and the guilt. It felt like a weight lifted off of me. It did open that door to have further exploration of unpleasant emotions and thoughts that I was pushing aside because I didn’t have a lot of pain anymore, so problem solved. Unfortunately, that’s not always the case. For me, it certainly wasn’t. For some, it may absolutely be the case. It took a little bit more and I’m still painful or emotional to talk about it. Being able to get through this talk and talk about it more led to other things opening up in my life. Once you’re able to open up the gates, you can allow for a lot more abundance to come through.

I was still not talking about the pain, holding it close thinking, waiting for the other shoe to drop. “It’s been several years, does that mean I’m don’t have the pain anymore?” You’re always waiting. I feel I’m always like, “It’s going to come back. I better enjoy it while I can.” After going to this talk and now having better tools to serve myself, I don’t worry about that as much. It’s certainly there. That opened myself up to a lot of other great things to come in, having a great partner in my life now. I have someone and he’s great. Would have never happened had I not done all this work ahead of time?

Starting to talk about your experience from the third person was a safe place and it was a little bit distant from where you are now.

It was my way of being protective, which is perfectly normal. It’s my way of protecting my true inner struggles because it’s a lot easier to go out, look polished and perfect all the time. It’s easier to do that than to let people see what’s going on sometimes. That’s why I chose to start it in that third person. I thought I was being clever.

It can be hard to embody all those experiences if you haven’t done any work to necessarily prepare yourself or maybe enough work. It’s a beautiful story of steps people can take to move toward embodying their own experience.

I tell patients who I see who’s had chronic pain, like, “Write it from the moment you felt pain. It can be clinical. It can be emotional. It can be whatever you want it to be. Not a timeline, but write it down. What did you feel at this time? What did you try and do?” I injected a little bit of humor into mine because that’s part of my defense mechanism. Now that I look back on some of the things I did, it was hilarious. The things that you will like to do when you’re in pain that is not funny at the time. I am not making light of it, but looking back I’m like, “I can’t believe I did all that stuff.”

You and I both know that there are physical therapists reading this who love it and enjoyed and other practitioners, not just physical therapists. I’m inclusive to everyone who’s reading this. There are going to be some practitioners who were like, “I went into this to do physical therapy and to treat people’s physical bodies. Here these two are talking about forgiveness. Their boot on the top of a mountain top.” What would be your response? I know it’s going to be hard for you to separate someone who has overcome pain versus a professional. Why should physical therapists learn more about this topic?

When you’re treating someone, you’re treating a fully formed human being, the whole person. That doesn’t mean the whole person from head to toe physically. It means the whole person who comes to you, especially someone who’ve had months to years of chronic pain. They’re coming to you with anxieties, guilt, fear, and resentment, with all of these complex emotions that run alongside longstanding pain, in my opinion. I don’t know if there’s an RCT to back that up, but in my opinion and my personal experience, as a practitioner and a patient that that is true. If you are not exploring some of these things with your patients, you’re doing them a disservice. You don’t know what the one thing is that’s going to unlock something in their brain to say, “I never thought about it that way before.”

That might be the one thing. If you’re only like, “I’m going to massage or dry needle,” or whatever else you’re doing to the patient, it might be nice to include them from all aspects, whether that be physical, mental, emotional, spiritual aspects of their life. You don’t know what part might spark something in them to say, “Wait a second. Now I get it.” It doesn’t mean that as the PT, are you the person to give them the mental or the psychological therapy that they need? Maybe not. You might be the spark for them to say, “I never thought about this. Do you know someone I can talk to about?” or “I never thought my diet being involved in this. You can make a referral.”

“I never thought about X, Y, Z.” You can make a referral to a life coach. There are a lot of ways as the PT who I would say arguably out of all health care professionals are spending the most time with this patient to address everything you can think of that could be filling up this bucket, that’s contributing to their pain because you don’t know the thing that’s going to make the difference. For me, it wasn’t anything physical. As a matter of fact, I hated the physical part. I hated being touched, stretched and massage. It was excruciating to me. I had a lot of allodynia. It was torturous for me. To hear David Butler allow yourself to not be so hard on yourself, that was the thing that I needed. I thought, “Maybe I will work with the life coach, who I had already known for a little bit.” It was those things that made me reach out to the people that I felt like you said before, “What do I need to help in my recovery.”

I have a new metaphor I’ve been using. Some people love it and some people don’t like it, but I’ll share it with you and everyone else here. It goes like this, “Working with the noodle, maybe more important than working with the needle,” which is a common thing that’s playing out in our profession.

I would agree with that. It’s the person’s perception of what their pain is of who they are as a person, as a friend, a wife, a mother, a father, an uncle, an aunt, mommy or daddy. If you as the therapist, can make a change in their perception of themselves, whether that be through physical exercise and movement, that can change your perception of yourself, whether it be asking open-ended, but pointed questions. Exploring things that might be uncomfortable asking them, sometimes just ask. Often when you’ve had pain for so long, you feel like you’ve told your technical story many times and no one’s listening. Ask and listen. If we could go first full circle back to when you ask what helped change that pain after seeing David Butler, it was he listened.

He sat down and said, “Tell me what’s going on? How does that make you feel? Why do you think that is?” I felt like, “This is somebody who is listening to me, who’s asking these questions, who’s making me a little uncomfortable but making me think about things in a different way.” He changed my perception. He did it by listening and asking pointed open-ended questions. Not by telling me what to do, but by unlocking things to make me realize that after all this searching of doctors and health professionals, that the person that I needed to “fix me” was me. I had to be ready for it. I had to understand what that change was. It’s hard. It’s a practice and I keep practicing it every day.

I want to lend some evidence to exactly what Karen is talking about. There was a 2012 study in the Journal of Disability and Rehabilitation that examined how forgiveness affected patients in an outpatient physical therapy center. Forgiveness of self was one of the most important factors, more important than forgiving others. According to the study, those who were able to forgive themselves had higher levels of healthy behaviors resulting in better overall physical health, mental health and reduce pain. The study found that participants had a much harder time forgiving themselves than forgiving other people or circumstances.

It’s always much harder to forgive yourself. That’s exactly what I have been meandering. The path I’ve been meandering through over for the past year is looking back on and forgiving myself for those feelings that maybe I had a resentment. Not for other people doing fabulous things. I’ll never resent other people doing fabulous things. I love it, but resenting my body for taking that opportunity away from me.

You’re well on your way through the process. You’ve told your story now in many different places. I know you continue to tell it. You’re transforming that experience in a way that helps other people. I’ve done some training in meditation. There is a mindfulness or meditation approach for forgiveness. Would you participate in that with me?

I would love to.

Everyone else at home can also as long as you’re not on the treadmill or driving. If you’re driving, gently pull over and place your car and park. Everyone else at home, if you can find a comfortable position seated up is perfect, feet flat on the floor and rest your hands on your palms. You can do this with eyes closed, which is probably the preferred way or you can gently look down probably about a foot or two in front of you. We’re going to spend a moment landing in the seat where you are and starting to take some nice, slow, steady deep breaths, breathing in and breathing out. As you’re breathing here, allow your shoulders to relax, allow your hands to relax, your feet to relax and let them mask drop whatever emotions you brought with you.

Allow them to release a little bit for a moment and connect with how your breath, it’s moving in and out through your belly. You can either say this silently to yourself in your mind or you can say it out loud with us and we’ll begin with forgiving others that have harmed you. The phrase we’ll repeat is, “If I’ve hurt or harm to anyone, knowingly or unknowingly, I asked their forgiveness.” Notice there’s any feeling or thought that arises with that, nice and easy. Touch down with any thought or feeling that arises. Not analyzing it, not judging it, allow it to be. Bring your awareness back to your breath for a moment and then we’ll start to bring in the second phase. You can say this silently to yourself or you can say it out loud, “If anyone has hurt or harmed me, knowingly or unknowingly, I forgive them.” Gently turn toward any feeling, image or memory that bubbles to the surface and allow it to be touching down with it nice and gently.

Once in your mind, repeat, “I forgive you.” Finally, we’ll turn our attention to forgiveness of ourselves. You may be wrapped up in a little bit of self-blame or some perfectionism. You can repeat in your mind or say it out loud, one side only, “For all the ways that I have hurt or harmed myself, knowingly or unknowingly, I offer myself forgiveness.” We’ll spend about 60 seconds here in silence. Allow whatever experience comes up to be there. You can take a nice deep breath in and bring your awareness back to your belly. Noticing how your belly rises and falls as you breathe. A little scan of your body from head to toe. Notice with any areas of tension or tightness that have come up. You may want to wiggle your fingers or toes to start to bring some activity in life back into your body. You can roll your shoulders a little bit. When you’re ready, you can open your eyes. Karen, can you share one thing you noticed?

I noticed that this is probably not surprising given our conversation, but when we got to the last forgiveness of the trilogy that if I have done anything to myself, either purposefully or not, I forgive myself. I’ve found that I can feel my heart rate go up a little bit on that last mantra and repetition of that mantra. I definitely felt like my heart rate spiked a little bit. I could feel it. It is still a little bit harder, but that’s something that now I can work on. It’s like a loving and kindness meditation, which I do quite often, where you project to a certain person, maybe to the world and finally to yourself. It goes in that order because it’s a lot easier to project to the world or project to one other person than it is onto yourself. That is true, as well as with the forgiveness meditation. If I had full socks on, I’d be curious as to what that said. It shows that it’s something that I need to focus on. I’m glad that I came to this realization of forgiveness. Perhaps that’s the next part of the next phase of what I need to work on.

I’m glad you’re working through all this too because, one, it gives other people hope, especially practitioners who have pain who are sometimes the most confused and concerned because they know about things. You’re a wonderful role model for that and your story is perfect for that. Your podcast and all the things you’re working on, it is going to start to add fuel in a good way to all those things that are coming. Speaking of which, tell us what’s coming.

It’s a couple of things. We’ve got a new season of the podcast coming that I’m excited about. Joe was going to be a part of that. We’re on track to launch a program to help physical therapists create their own practice. Mostly focusing on a private pay or a cash-based practice, focusing on a concierge model, which is the model that I use in the Mobile PT model. It’s going to be a very comprehensive program that’s not me bringing in a lot of different people from different professions to come in and help. We’ve got a lawyer, a PR professional, marketing professionals, copywriters, all these other physical therapists who are also at the top of their game to help us break down. How can we create this business that is meaningful to us, that’s meaningful to the person taking the course?

That also gives you all the practical guidelines and steps that you need to take. It’s the stuff that I wish I had when I started my practice a while ago. Joe, you could probably relate. When you started your practice here in New York, you were like, “I wish I had something that could shrink it all down and give me good steps that I have to take.” I don’t want people to make the same mistakes that I did when I opened up my practice because it costs time, money and it then, in turn, costs the people who can see you and, and take advantage of your expertise in your health. It costs them as well. It’s a way to open up physical therapy to a lot more people. The ultimate goal is to help more patients. When you’re talking about creating a private practice, you’re doing it because you want to help patients in the way that you feel is best for you and best for them. That’s hopefully what this course will enable people to do.

We need more physical therapists in the world, helping people. There’s such a great need out there. As many as soon as you read things like, “The field is flooded in. This place is flooded.” I’m like, “It’s not. Don’t even listen to that.” Out of your mind, there are plenty of people that want, need and are yearning for your help as a high-quality physical therapist, which anyone who follows our work is.

There’s much to go around. I look at New York City. There are PT places all over the place in the city and yet there are many people who need it. There’s enough to go around.

It’s such a prime time for physical therapy in the healthcare system. People are understanding better what we do. They understand the value that we bring. We’re cost-effective. It’s important no matter where you live, whether it’s the United States or somewhere around the globe. The message is starting to hit, which is interesting because you and I both in practice it’s about 1997. It wasn’t always like that and now we’re fortunate to be functional. We’ll share all that information. We’re looking forward to that program that’s going to be coming out.

I know it’s going to be awesome. I’ve had a little bit of an insight into it. It looks exciting for people, especially for physical therapists looking to start a cash-based practice. I want to thank you for the time you spent sharing your story with us being open and vulnerable, which is wonderful. I know people are going to love this episode. They’re going to take this episode and hold it close to their heart both for themselves as well as the people they’re treating in practice. Let us know how we can find you. What’s your website?

It’s easy. It’s KarenLitzy.com. If people have questions or they want to talk about their own experience with chronic pain or their practitioner, they can email me at [email protected] or you can find me on social media, Instagram is @KarenLitzy. Twitter is @KarenLitzyNYC. It could not be easier. Try and make it easy.

Her podcast is Healthy Wealthy & Smart. Make sure you Google that, check that out and subscribe to that.

Thank you. I love these conversations because it gets me thinking more about how I can better serve my population of patients. I appreciate you for such great conversations.

Make sure you go and check out KarenLitzy.com, whether you’re a physical therapist or someone with pain. There are lots of good resources there, amazing podcasts that she has. How many are you up to?

It’s 460.

Karen started a podcast years ago. It’s an excellent podcast for those of you who are physical therapists and want to check out some information. Those of you who are not physical therapists but are interested in certain topics around pain and building practice is great information there. Make sure you take this episode and share it with your friends and family on social media, Facebook, Twitter, LinkedIn, Facebook groups, wherever you are. Karen’s breaking ground, lots of different topics, forgiveness being one of them, talking about your chronic pain story being another, and private practice, physical therapy is another. I wish Karen lots of love and luck. We’ll see you next time.

Important Links: 

• Healthy Wealthy & Smart
• Karen Litzy Physical Therapy
• Align Conference
• David Butler
• APTA
• Explain Pain
• Explain Pain Supercharged
• [email protected]
• @KarenLitzy – Instagram
• @KarenLitzyNYC – Twitter
• https://www.Facebook.com/KarenLitzyPT/

About Dr. Karen Litzy, PT, DPT