How Yoga, Mindfulness, And Meditation Can Help Relieve Chronic Pain With Stephanie Carter Kelley, PT, PhD

Welcome back to the Healing Pain Podcast with Stephanie Carter Kelley, PT, PhD

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How Yoga, Mindfulness, And Meditation Can Help Relieve Chronic Pain With Stephanie Carter Kelley, PT, PhD

We are speaking with Dr. Stephanie Carter Kelley, who is a board-certified orthopedic physical therapist and has integrated both mindfulness and yoga into her physical therapy practice to help support people with chronic pain. Stephanie is a physical therapist and she also has a Ph.D. in HigherEducation and has combined her knowledge and experience into an online integrative practice as a yoga physical therapist. She provides therapeutic movement, lifestyle health coaching, and pain neuroscience education for women with chronic musculoskeletal pain. In this episode, we will discuss Dr. Kelley’s journey as a physical therapist and a yoga therapist, and how she came to implement yoga as well as mindfulness meditation into physical therapy practice. Let’s meet Dr.Stephanie Carter Kelley.

Stephanie, welcome to the show. It’s great to have you here.

I’m so excited to be with you. I’ve been reading for a long time. It’s fun to finally get a chance to talk with you.

I’ve been following along with you on social media. You have some incredible videos on physical therapy, exercise and yoga. There are so many different topics that you include under your umbrella of treatment which is why I’m excited to talk with you. Speaking about all those things under your umbrella, when I looked at your bio, history and education, you still have lots of hats and have worn lots of hats. That includes a physical therapist which is a clinician and educator. You have your PhD. That’s a researcher and a person living with pain which blends so well with everything we do here on the show. Tell me how all of that developed for you.

HPP 235 | Relieve Chronic Pain
Let’s reflect on our habits and then look for ways to change them.

 

It’s all surreal looking back to see how your entire life ends you up in this space. I knew from high school that I was going to go into physical therapy. I took a test in high school that said, “This would be a good career for you.” I was like, “I don’t even know what that is.” I met the two physical therapists in my small town. They took me under their wing and showed me the ropes. I was like, “This is good stuff.” I always knew that was my path.

As I started into PT school, because that was back in the day when it was a little bit stressful to get into school, I started having back pain and neck pain. I was the student that they would call to the front, assess and see what was going on. I lived with it. Even though I tried to do all of the things in physical therapy that I knew I was supposed to do, I still had pain. I would go ebb and flow, have new pain and try to investigate that.

Education-wise, teaching gave me more insight into the body and I tried new things. I always think that the answer to my chronic pain was going to be around the next corner and it never was. I was an active woman living with pain. It never held me back from doing things but it was always there. I would go through periods of my life where I’m like, “I don’t want to deal with this anymore,” and go look for an answer, not find an answer and come back to living with it.

At one point in a period of my life, I was training for triathlons and I couldn’t stick to the schedules because I would have so much pain after running. My low back would hurt. I would work yoga into it and I always felt better. I had a baseline of yoga, so then when I had my kids, that blew everything up. Everything hurt after my first child was born. I returned back to yoga because that was all I could do. One day, I was going through my sun salutation. I was like, “There’s something healing about this yoga practice that I haven’t experienced in all of the other therapeutic activities, exercises and interventions that I had done.” I started on that path.

You went to PT school a couple of decades ago.

I graduated in 1990.

That’s six years before me. That was a stressful time to gain entrance into PT school because there were few programs, unlike now, where there are a lot more programs and opportunities which is great. Programs are different back then. The curricular was extremely dense.

I graduated with a Bachelor’s in PT. I moved to South Florida and early on went and got a Master’s in Physical Therapy from those people down there. I got a lot of the updated education through that Advanced Masters in Orthopedics. That was when a distance-based education program was in a different county. They came from Dade County to Broward County, where I was living. That’s where we did our Master’s degree.

When did the PhD and that work come in?

I went for the Master’s because I had this desire to teach. I’ve always loved education. What I’ve come around to know is that I’m a teacher first. My content is the body, physical therapy and now blending in this yoga. I was always a teacher. Education has always been a value of mine and something that I love because it keeps me delearning myself. After I got my Master’s degree in PT, I was looking for some opportunities to get a PhD. I got to come back to my home state of Ohio where Ohio University offered a lab instructor position. I came into their PT program as a lab instructor and clinician. It’s a rural area. They also had a PT practice associated with the PT school. I got to do both for a while and then shifted over into a faculty position and worked on my PhD in Education at Ohio University.

You mentioned before that you’re starting to do yoga and you’re finding, “This is beneficial for me.” If you start to reflect on the research now, there are tons of research on yoga for many different types of chronic pain syndromes. Some of it is looking better than “traditional exercise.” No one talks about it that much. It’s talked about in our professional circle in physical therapy but my current lens is there’s separation. It’s like, “The yogi PTs over here and your traditional ortho PTs over here.” Maybe now you have your “pain science people” over there. It’s three circles which sometimes overlap and sometimes don’t. What’s your assessment of why yoga “works” for pain?

I started with analyzing physical practice because I was a physical therapist. A lot of it is much like we do, therapeutic exercises. That was nice and you can incorporate it into a flow. Maybe it was the compliance factor. People wanted to continue with a yoga program versus a therapeutic or home exercise program. That could be part of it. It’s a little bit more fun. The second one is it’s functional at all. There are some poses in yoga. Let’s take the triangle pose. It’s the weirdest, most awkward pose you could possibly do. I started thinking, “Why is this a good pose?” As a physical therapist, there are some poses that I would have never tried to teach my patients and clients.

Thinking about the triangle pose is so awkward. I thought, “Maybe it is to help us break the bad movement patterns that we have done our entire lives and create new ones. Let’s be a little awkward in this pose.” The awkwardness makes you feel it. Let’s take sit to stand. We’re trying to change people’s knees and hips. We do sit to stand over again. That’s hard to change the habit but let me take you into some weird yoga poses. Now, let’s come back to that functional activity in a new way. We talk about in yoga the samskaras or the habits. It makes us reflect on our habits and then look for ways to change them.

Rather than try to undo faulty movement patterns, you’re with yoga. You’re adding new movement patterns to the neuromusculoskeletal system. The new movement patterns inform the older ones that may not be working so well.

As much as we like to in our biomedical model to separate things into silos, I don’t think we can do that. That’s why I’m going to suggest many ways that yoga might be helping. It is, however, that brain and body connection too. It all starts with awareness. All of the cueing, even with a traditional yoga class, is all about how you feel in your body right now. Those are the times when people end up crying on the mat because no one has ever asked them to feel what’s going on in their bodies at all. I always say they dissociated the brain from their body. They don’t know how to do a pelvic tilt or a cat-cow. They can’t even create that motor program. They’ve frozen.

That led me to look at the autonomic nervous system and what was going on with the autonomic nervous system. I don’t even remember learning the autonomic nervous system in PT school. This was all new to me. One of my wonderful students handed me a book, Buddha’s Brain. She went, “You need to read this.” I was like, “Cool.” That was my first like, “I don’t even know this whole autonomic nervous system.” That sent me on a path to understand that much better. I knew from there that all of my life as a physical therapist, I had only been dealing with the physical triggers that lit up people’s pain. All those things, “You’re standing wrong. Your posture is not right. You’re walking badly. You’re weak here.”

It led me to understand more than all of the social, emotional, psychological, cultural, environmental and financial triggers along the same pathways. As an academic physical therapist, I thought a lot about why my clients aren’t getting better. “Every time you come back, you have the same exact tension in your neck. All my manual skills and stretching does no good. You come back with exactly the same pain.” My famous line now is, “What else is going on?” I use that a lot.

You mentioned someone having an emotional response on the mat, which is common. I’ve seen instructors handle that in a delicate, beautiful way and instructors that don’t know what to do with it. It’s a situation that happens over there and it passes. From a clinician’s perspective and starting to put together everything you know about the physical body, mind, brain, nervous system, autonomic nervous system and psychosocial factors, how do you start to unravel that and explain it to someone who may be in your group? It can be very confusing when you walk into a yoga class and you think, “I’m here for exercise. All of a sudden, there’s this experience that I didn’t expect was going to happen. What does it mean?” They’re important opportunities for health and wellness professionals to help someone through.

I probably experienced that more in the one-on-one situation. Let’s take the group situation. You create the space that allows people to feel safe enough to have that emotional release. I have never been a yoga instructor. It’s hard for me to consider myself a yoga instructor. As a teacher, I do not like people to drop in and out of my classes. I want you to come and spend some time. I’ve always said, having been a physical therapist, “I want to see your progression.”

I had a very consistent group in my classes. It got to be a group that as new people would come in, the existing people got so that they would welcome them. A lot of times, the experience was more comment of, “I’ve never felt this before. You do it in such a different way.” I wouldn’t say in a group setting I ever had somebody in my class. I’ve been in classes where this has happened. What I would hear from the students was, “I’ve experienced that too.” There’s that social piece of yoga. That’s another one. When you can create that group of support, that social support within that group is so powerful.

HPP 235 | Relieve Chronic Pain
Create a safe space for people to have that emotional release.

 

I have one student. She has been a long-term friend of mine. She is a retired physical therapist and she has some physical disabilities herself. She is limited, yet she has gained amazing abilities in this class. She was the first one to say, “Keep coming. You’ll get there.” There’s a lot of social support. When it is me in a private session, I almost always get tears because I’m the only person who has said, “What else is going on?” I hear your history of pain, physical treatments and surgeons. Other health professionals are telling you that there’s nothing wrong and not validating you. I’m validating you, “Around the time that you began having this pain, what was going on in your life?” That question is what brings the tears because nobody has ever helped them connect their psychosocial, emotional stress with the pain that they’re experiencing.

The mindfulness component is included in a quality yoga practice. When you start to tweeze that apart, there’s a disconnect or dissociation between the mind and the body or the brain and the body. Yoga is a very open practice that helps build awareness around many different types of sensations in your body. Some of those are sustained, which can be difficult for people to sustain certain postures and physical sensations in their body. You look at, “We have mindfulness as part of yoga. We have the physical aspect of it.” When you’re teaching, are you conscious about all of those interventions? It’s one intervention but there are components to that have been identified in research and broken down to try to figure out, “Yoga works but why does it work? Is it exercise, group setting, interoception training, mindfulness or the cognitive change aspect of it?” What’s your approach and take on all that?

I do some PT-OT education around yoga. I go through a class where I highlight every single cue and how it relates to whether it is addressing the nervous system, it is a little bit of education for pain science or it truly is that aspect of mindfulness and bringing awareness. I was doing yoga for a while and I knew that I needed more mindfulness and meditation training. It wasn’t yet a part of my practice. I was following the Iyengar lineage for a long time. Iyengar says, “The movement can be the meditation.” I sat with that for a while. I was like, “Okay,” but I knew I needed to move into the sitting still, which I knew my brain needed and the breathing.

At least once a year, I try to do some yoga teacher training. Two things merged at once. I picked up a book, You Are Not Your Pain, by Vidyamala Burch and Danny Penman. It is based on mindfulness-based stress reduction, specifically for chronic pain. I went off to my yoga retreat thinking, “I’ll have time to delve into this.” The yoga retreat was with Judith Hanson Lasater, who was a yogi first, a PT second but very introspective. She was doing a whole training on empathy and gave us some homework to listen to our inner voice, which made me a little bit scared because I try to shut all that down because it’s so active. The two things merged. I realized some of the inner sources of my pain were listening to my brain, the harshness of the tone and self-criticism. I realized that I needed more mindfulness to pay more attention to what was going on inside my mind and how the two fit together. After six months, I practice mindfulness every single morning.

How many minutes?

It would vary. When I started, I was in a bad job situation. I wasn’t sleeping well anyway. I said, “Instead of lying here, I’m going to go meditate.” I used all guided meditation and a variety of styles because that’s me. I’m the researcher. I got to try it all. I had a Meditation Summit from Sounds True, which came with lectures and the meditation or the mindfulness practice. It’s extremely interesting to see all the different kinds I had no idea. I was doing some Deepak Chopra and Oprah meditations, Jon Kabat-Zinn, short and long ones.

I have a researcher here at Ohio State, Maryanna Klatt, who had done some research on shortening it to twenty minutes. I played with it all. Longer is better. Start anywhere, even one minute and one breath, but progress longer. We know that from Sara Lazard’s research that there’s a dose-response to meditation and mindfulness that longer is better. Forty-five minutes is recommended from the Jon Kabat-Zinn or in the mindfulness-based stress reduction.

That’s a long meditation for people. A lot of the research shows that five minutes is where change starts to happen. We encourage people to go longer like with exercise.

Dose it up. That’s why I say any amount is good to start.

I want to go back to what you said about the sleep aspect of it. You weren’t sleeping well. Instead of lying in bed, staring at the ceiling, watching the TV or roaming the house, you chose to meditate, which is a wonderful skill to encourage people to engage in when they can’t get to sleep or fall asleep.

I highly prioritize sleep now. I even tell people to use guided meditation for sleep. Here’s another clue. If you’re waking up in pain, most likely it started with the stress that you took to bed and you didn’t get into restorative sleep. I encourage people to use some music or meditation at night to go to sleep because sleep is so important.

You said, “Movement can be the meditation,” which I agree with. However, my question is, as an instructor leading a class, how intentional do you have to be about providing the cues for movement to be the meditation? Just because you go to a yoga class doesn’t mean that it’s effective movement-based meditation. Meaning it has to intentionally be taught that way. When it is taught that way, then you can combine both. Yoga started first and then meditation came based on a lot of the history. It grew out of yoga first then meditation. You said, in some of your training, you teach about cueing and how that cueing relates to mindfulness, pain science or other aspects. Can you give a couple of examples about those and how they relate to some of the topics we’re talking about?

The format of my classes and I’ve explained this to my students. We start by slowing down first. We start with breathing as the meditation to get the nervous system in a state that it can now pay attention to. I lead people through, especially my beginners, a very long breathing practice because awareness of breath is the first accessible way to meditate, pay attention and be mindful. I lead them through a three-part breath, deepening the breath, then a longer exhale which is to deactivate that sympathetic nervous system and move them into that parasympathetic state.

I tell my students like, “Eventually, we’re going to start moving a little bit more vigorously but I don’t want to take you into a vigorous movement unless you’re ready to pay attention to what you can do on this day.” So much of my cueing is to feel where you are now. “Do you have energy now or are you tired now? Are you sore from what you did yesterday?” We don’t do yoga every day but I have people that walk and do other types of exercise. “Did you have a stressful event yesterday emotionally and now you’re not ready for that?” It is guiding them all the way to the correct parasympathetic response so that they can pay attention and connect their body to their brain.

We move gently and I consider gentle movement. This is one place where I had to change my beliefs about the benefits of gentle movement. The gentle movement did not fit into any of my buckets of therapeutic exercise. It didn’t fit into strengthening, range of motion for the purpose of increasing the range of motion or into any of my physical therapy intervention buckets. The gentle movement though does fit into the interoceptive, the awareness practice. I resisted gentle movement at first. I was like, “That can’t be a goal. We have to do more.” It has been a process for me to accept all of the parts of yoga. The gentle movement now is purposefully a mindfulness practice.

My clients, patients and students have taught me that. Every once in a while, in the studio, I would do this super gentle practice where we wouldn’t leave the floor, roll around, move our arms and do tons of cat cows. In the end, they were like, “That felt so good.” I was like, “We didn’t even do anything.” They taught me to be gentle. They would leave with less tension because by the end they were in a parasympathetic state. They were at rest and digest without going to sleep.

I’m certified in Pilates and have used it for years with patients. I was a gymnast. When I came to PT school, I had already done lots of activities, exercises and sports. I came out of PT school with a great foundation of all that. I felt confident using exercise. However, when I found Joseph Pilates’ work and he organized all that into a system, there was this light bulb that went off in my head because I was working in a larger clinic with lots of different therapists. When someone came in with back pain, one person was doing this exercise. The other person was doing that exercise. I’m all for flexibility but there was zero standardization and no system at all.

A system can help, especially in new clinicians to organize themselves and create an effective treatment plan. Did you find that when you first came to yoga like, “Here’s a system that I can use for my practice, health and well-being?” Why are we not doing more of this in physical therapy? Why are we not taking exercise and trying to systematize it? Contemplative practices have been around for centuries and we take that and study it then we can say, “This group of exercises help this patient population.” Why are we not doing that more in the world of PT?

HPP 235 | Relieve Chronic Pain
Use guided meditation for sleep.

 

One thing about yoga though is that there’s a format for class but not everybody follows it. Hatha, Vinyasa, Anusara, Ashtanga, Iyengar, there are so many types of yoga. Some people don’t spend any time on breathing and meditation or Shavasana at the end. It’s not systematic.

I’ve seen that come out of yoga over the years. When I first started doing yoga in 1996, there was a great place in the West Village in New York City called Integral Yoga. Their classes were 1.15-hour long. It was typically about one hour of the hot yoga postures in the last fifteen minutes. It was the meditation, Shavasana and I loved it. It opened me up to mindfulness first. I didn’t study mindfulness too many years later but I did that for years. I went there for years consistently and then they changed their course schedule. I was so angry that I was like, “You’ve taken away a big part of what this whole experience is about.”

So much of it is the marketing. They’re marketing it to what people say they want but not what they need. That has been one of the difficult parts of leaving traditional practice and creating a marketing message to attract people is, “I know what you need but that’s not what this culture tells you what you need.” My clients are pretty much women my age and older. I’m 53 and all of the moms that I hang out with are about ten years younger than me and they’re not my students. They don’t think they need it now. I can look and say, “Come talk to me in five years.” They’re not there yet. Maybe there is some maturation or evolution that leads you back to it. I don’t know.

Back to the system, it is interesting. I love the work. I spent a lot of time thinking about low back pain or habits. Spine pain was my specialty in the clinic. I like it all. I liked the complexity or what other people thought was the complexity of treating people with spine pain. When I worked in sports medicine, they all had their specialties. They were like, “Please take all the patients that have back pain.” I was like, “Yes.” The work of Robert Saper. He has done a lot of research on yoga for people with low back pain. He has a population of minority low-income. It’s how he defines it. They have amazing results with yoga twelve-week practice. He has done several studies but looked at whether you need once or twice a week.

He has got it down to one time a week for 1 hour for 12 weeks but sending home people to try to do at least 20 to 30 minutes on their own. They keep a journal to see if they do that. They took that same practice and compared that to physical therapy of the University of Pittsburgh group that has researched the diagnostic categories for many years now so that they are matching their interventions to the diagnosis. Fifteen visits one-on-one versus group yoga, results were the same. It blew my mind when I saw that because we have this belief that one-on-one is better and that you have to match the intervention to exactly what the assessment says and the generalized yoga program did just as well.

I’m a big advocate for ACT for pain. It works very well and has lots of research to support it. There are some papers out there when compared to yoga, outcomes are the same.

I was reading your Radical Relief book about ACT. I have a good friend who was in the yoga studio with me. She’s a professional counselor and she specifically used ACT. We were going to do some workshops for people with pain. We would talk back and forth about the process and how to blend it. I knew some stuff about ACT and I’m sure there’s influence. My process when I read your book and I looked at this process that I’ve developed which is not linear, which is why I like that graph of the ACT because it’s not linear at all. The PEACE process that I use is very similar to ACT which if I was more schooled in ACT, I probably would have said, “I don’t need PEACE. I’ve got ACT.”

Don’t throw away PEACE. Tell us about your PEACE framework because I love frameworks.

It did take me a while to evolve this process. P is that Practicing awareness that I talked about. It’s the first step. Whether it’s movement, breathing or meditation, it’s practicing awareness consistently and frequently so that you can pay attention in the moment, which is mindfulness. E is Educate. I bring that from physical therapy. Patient education was always so important but now what to me is even more important is that the person is educating themselves about themselves. What’s going on in here? What is everything in your brain? All these thoughts and beliefs, where is that coming from deeper down within your spirit?

You and I have been practicing for a while now. Let’s say the early ’90s. Patient education was always a thing. It was always very important to the practice of physical therapy.

I always thought it was the most important part.

It has evolved into pain education but what I don’t like about pain education is the idea that you’re going to do this to someone and they’re going to get better, versus what you said is engaging them in a journey about learning about their total pain. When I say total pain, I mean how their mind and body interact.

The other thing I love about yoga as a wellness practice is we both know that the episode of insurance-based physical therapy is not enough. We need something that will carry them on. My pain history is I had stomach aches as a child and so I have 50 years of pain. That doesn’t go away with six weeks of physical therapy. This practice, I feel like it’s enough. I was talking about my students because I have a healthy conversation associated with my class. It’s a coaching PEACE that I do. I said, “I teach this stuff because I needed to.” We were talking about nonviolent communication. “You can only work on one little part at a time. You can’t pay attention to everything.” My problem with pain education is they’re trying to give you all of it all at once. It’s like, “I can’t take all that in.” Let’s take the pieces and parts, integrate it and then take a little bit more. It’s a long process.

The idea that an insurance company provides on the high end twelve weeks of care for someone with fibromyalgia is trash. The fact that we all accept that as professionals and don’t use our voices more to advocate is the direction that I take this show and a lot of my work. Even in my book, Radical Relief, I tried those chapters in there are tiny for a very specific reason. Even in the front of my book, I’m like, “Read one chapter a day and no more.” I think one chapter every other day would probably work for most people.

That’s the same little bits that I try to give on a weekly basis with what I would call my level one yoga classes.

P for Practice, E for Educate.

A for Assess and that is self-assessment. I’ve taken a lot of our PT examination and give them back to clients as self-assessment tools but also what it might be even more important is that assessment of their own core values. I saw this in the ACT process. Core values are your guiding light. You will better understand your social, emotional, environmental and physical triggers for your nervous system when you understand what your core values are. When you have appraised your core values, you will know what the next right action is to take based on your core values. C is Create, going back to creating new habits of movement, thoughts and beliefs. Get rid of some of those old limiting beliefs and try believing something else for a while and see if that helps your pain.

E is Empower. People need to stop looking outside of themselves for the answers, surgery and invasive interventions for pain are so out of control. That triggers me when I start talking to somebody. Usually, it’s not a client of mine but somebody who is looking for a surgeon or this, that and the other thing. I’m like, “How did they get to have all the answers and I have none?” Sometimes it feels like I have no answers or that nobody believes my answers. Our culture has given that quick fix the priority, hard work and introspection not so much.

This is something I put in the front of that book Radical Relief in a one-liner. I talk about this when I talk about pain in the book. People ask questions like yourself like, “What’s wrong with our system that we don’t treat pain properly?” I’m like, “We have a billion-dollar medical and pharmaceutical industry that has modified people’s beliefs. Most of it for financial gain and we haven’t unwound that yet.” People ask me, “Why did you start a podcast?” I’m like, “I want to give people a public service announcement.” There’s no public service announcement out there, so I started one. People like you helped me and collaborated and we talked about this. The idea that we still have a billion-dollar global medical and pharmaceutical industry that is not treating people safely or effectively is a human rights issue.

I’m not holding back anymore. That’s the only reason I’m using social media. I’m still learning how to use it effectively or make it pretty so people will pay attention to it. There’s no reason. I try to get people to understand the conflict of interest around the opinion that you need surgery. If the surgeon doesn’t tell you that you need surgery, that’s their job to tell you need surgery. The only way they make money is if they do surgery. Pain doc is the same way. The only way they make money is if they do an intervention for you. Why would they turn you away? Why would they tell you that you don’t need surgery?

The same thing with physical therapists that work in the system. Columbus, Ohio, has a lot of physician-owned physical therapy services. I keep listening to the clients coming from them saying, “The surgeons know I didn’t need surgery, it wasn’t bad enough for surgery.” The therapists in that environment don’t know what to do. They know how to do post-op rehab but they don’t know how to problem-solve. These were some of my students.

It’s what the system does because people get caught in that system. They wind up with one surgeon and then back to the next doctor for injection then back to this doctor for medication and maybe to the PT. It’s a constant retraumatization process.

I love there’s so much conversation about trauma-informed yoga. Finally, at CSM, I started hearing some conversations about trauma-informed physical therapy. For some reason, it’s still only in the pelvic floor area.

It’s so fascinating you bring that because CSM passed and I’m sending in some sessions in 2022 which will be in San Antonio. In my first book, I wrote about breaking down silos like, “The mind and body are treated here then you have nutrition there. This is silly. All this needs to come together.” Now, I’m looking at our organization within the APTA which I support and a member of. I was like, “Talk about bringing down all these little pieces of a puzzle.” It’s not a popular opinion to have.

I listened to the biomechanics session. Our heavy hitters in research and biomechanics questioned why some muscles don’t fire and why we have some of this dysfunction. They can measure and see it. I thought and talked about this on my Facebook Live, “Why don’t the glutes fire?” Let’s talk about the glutes. How much have our glutes been traumatized in our culture and society over the last hundreds of years? We spank, pinch and slap them. We call them names. We either hide them or show them off. If we show them off, we’re probably not all that confident about what we’re doing. There’s a whole lot of social, emotional and cultural that goes into the glutes and we wonder why they don’t fire.

Some people will say, “That whole thing about firing patterns, there’s no research behind that.”

They made it clear that there’s some interesting research behind it from a biomechanics perspective.

It goes along with dissociation. We know that people dissociate from their bodies. That research is done. It has been completed. “Why can’t I dissociate partially from a part of my body?” You can.

It’s one of those things like, “Now that I see it I can’t unsee it.” I’m sure you feel the same way. Sometimes it would be nice to go back into my physical therapy bubble and stay there but I broke out of the bubble. It’s the most fun I’ve ever had, feeling like I’m helping people at that deeper level that will help them in the long run. I feel like it’s much more fun.

Stephanie, tell us what’s new for you in the future and what you’re looking forward to?

I’m having a lot of fun online and hoping to grow. I have an online membership that is this blended yoga physical therapy. It’s only for women with chronic pain. They join me a couple of times a week where we do some real interoceptive work in one class and then some strength training in another class. I break out the clusters of classes also and sell them as bundles or packages. I’m excited about treating osteopenia and osteoporosis with more strength training in general. I enjoy the strength training practices that we do. My family is getting ready to make a big move. We’re moving from the city to the country. We’re looking forward to that. That’s the big thing that’s in my life is from suburban life to country life. I’ll let you know how it goes.

Keep us up to date on all your work. Thank you for joining us on the show. You can learn more about Stephanie at her website, StephanieCarterKelley.com. If you know colleagues, friends, patients or clients who are interested at the intersection of yoga, physical therapy and chronic pain, make sure to share this episode with them on your favorite social media handle, Facebook, LinkedIn, Twitter, Instagram or pop it into a group. Maybe that’s a Facebook Group where people are talking about all these topics. I wish you well and I’ll see you in the next episode.

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About Stephanie Carter Kelley

HPP 235 | Relieve Chronic PainStephanie Carter Kelley is a Board Certified Specialist in Orthopaedic Physical Therapy with a PhD in Higher Education offering her a variety of career roles from treating patients in hospitals, outpatient clinics, and home health care; academic teaching and research; and quality improvement administration.

Her knowledge and experience has culminated into an online integrative practice as a Yoga Physical Therapist.

She provides therapeutic movement, lifestyle health coaching, and pain neuroscience education for women with chronic musculoskeletal pain. Her unique process, PEACE out of Pain, includes 4 steps toward one goal: “Empowered to Care for your Own Health”.

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