Welcome back to the Healing Pain Podcast with Andrea Moore, PT, DPT, OCS, FNTP
This is our last episode in The Radical Relief series. It’s bittersweet for me to end this series because I enjoyed speaking to these great clinicians, researchers and academics that are using Pain Neuroscience Education, mindfulness, and Acceptance and Commitment Therapy. I want to take a moment to express my deepest gratitude to each speaker who appeared during this series and share their great information starting with Adriaan Louw, Davide Lanfranco, Mary Doyle, Annette M. Willgens, Lilian Dindo, Mary Grant, and our guest, Andrea Moore. If you’ve missed any episode in this series, make sure you go back to December 30th, 2020, with episode 209. You can start there and then work all the way through each episode until you arrive at this episode.
I’m joined by Andrea Moore, who is a physical therapist and a recovering health perfectionist. Early in her career, she focused on trying to fix everything that seemed to be wrong with her. She’s dealt with chronic pain, post-concussive syndrome, anxiety, depression, and ADD. She now helps other overwhelmed women suffering from chronic pain to achieve a healthy and active lifestyle. In this episode, you’ll learn all about chronic pain and how perfectionism contributes to chronic pain, as well as Andrea’s evolution from becoming a doctor of physical therapy, implementing nutrition, and now informing her practice with Acceptance and Commitment Therapy.
If you’re interested in learning how to combine these multimodal approaches that we discuss on this episode, including Pain Neuroscience Education, mindfulness, and Acceptance and Commitment Therapy, make sure to check out my latest book, Radical Relief: A Guide to Overcome Chronic Pain, which is available on Amazon. Let’s begin and meet Dr. Andrea Moore, and learn all about the connection between perfectionism and chronic pain.
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Mindfully Approaching Perfectionism, The Patriarchy And Pain With Andrea Moore, PT, DPT, OCS, FNTP
Andrea, thank you for joining me on the show.
Joe, it’s great to be here.
I’m excited to talk to you about everything you’re doing because it’s extremely unique, your practice, and the practice you’re developing for yourself. I can’t wait to share that with you. You have become such an amazing physical therapist with all these different skills. First, I want to talk about a topic we haven’t spoken about on this show with regard to chronic pain, and that’s perfectionism. When you sent this information over to me, I even had to pause and think about my life as a physical therapist. Even getting into PT school requires perfectionism, and then pain itself sometimes requires perfectionism or can lead to perfectionism. Make the connection for us between perfectionism and pain of all types.
Everyone who’s reading this knows that pain is caused by nervous system sensitivity. A lot of things that drive perfectionism also lead to heightened nervous system sensitivity. You can have them relate to each other. Chronic pain can also lead to that perfectionism mentality. You can have perfectionism lead right into chronic pain as well.
How did you start to touch in on perfectionism itself with regard to your practice, and identifying this with your patient population, and bringing this to the forefront? In some ways, it’s a personality type. What’s refreshing to me about this is it’s important that we talk about things like fear avoidance and avoidance of movement. These are essentially important topics to talk about, but that’s not the only emotions and problematic thoughts that come up with regard to pain.
A big reason is one of the first patient populations I worked with was in a privileged area. It was in a cash pay clinic in the DC area. You have a lot of type-A, very driven, and incredibly successful people that are attracted to this practice. You start to see this idea that bodies have to be perfect, and that is such a thing that is very common in our culture of having this perfectionism around bodies, both from how they look, but also from how they feel. You start to notice in some people where the pain itself, when you look at what the pain is causing, it’s minimal. It wasn’t impacting them from doing the things they love. It wasn’t necessarily stopping them from anything, but they wanted to fix it because that meant their body wasn’t perfect, that they were broken, and something was wrong with them.
Having pain is seen as, “Something is wrong with me.” In reality, pain is a normal part of a human experience. It would be weird if someone didn’t have pain. That was one aspect that I saw. You also see it from the standpoint of when you are working with someone who needs physical therapy and has benefited from the work. They had these massive improvements and these huge shifts, but it’s still not perfect. That need for perfection wipes out all the other good that they have experienced and all the other improvements they experienced. It’s almost like they didn’t even matter. They couldn’t even celebrate any of those because it wasn’t perfect.
Is this a topic that you started talking about with your patients naturally? Did you start to dig into the research on your own and discover, “There’s a whole body of research with regard to perfectionism and pain?” Did you include that in your evaluation with regard to treatment? What does that look like?
It organically came up, and it came up in my own story as well. For myself, I was one of those people that was seeking perfectionism. Ironically, had you told me that years ago, I would have laughed. I would have been like, “Are you kidding me? I’m a hot mess.” I’m so far from perfect. That’s not my issue. I’m a successful person, but I couldn’t even see my own successes because they weren’t up to these incredibly unattainable standards I was setting for myself. A lot of people mistake things like procrastination for perfectionism, or they’ll call themselves lazy. They’ll use adjectives that are the exact opposite of perfectionism to describe themselves because they’re deeply entrenched that everything has to be perfect. If I’m not that, then I’m a hot mess, a lazy slob, or I can’t do anything right type of mentality.
That was me. That was part of my own story. I had my own issues with chronic pain, ADD, bad concussion, post-concussion syndrome, brain fog, a myriad of symptoms. Even before my concussion, I sought out all these holistic practitioners because I wanted to be even better. I felt like I wasn’t quite right because my brain didn’t work quite the way that everybody else’s did. Therefore, something was wrong with me and I had to fix myself. I spent years and thousands of dollars trying to fix myself when it turned out I wasn’t really broken. I just operate a little differently than other people and that’s fine.
Before we go onto the next question, was that perfectionism showing up in your career? Was it more your personal life? Was it something that was inside you that wasn’t visible on the outside?
It was not visible on the outside. On the outside, most people would see me as very successful. I got my doctorate and board-certified. Most people look at me and be like, “Here’s a successful young woman.” Whereas on the inside, I felt very broken. It did transfer early on negatively into my patient care. I had the perfectionism mentality for my patients at times of if I would do something and it would help, but it wasn’t quite there, I’d be like, “It’s not quite right.” I’d almost transfer these perfectionistic qualities to my patients, which undermine my own treatment for them.
Often on this show, I interview experts. It’s all about, “Here’s what you do. Here’s the best way to do it.” It’s rarely that someone is humble enough to say, “Here’s what I wasn’t doing right. Here’s what wasn’t optimal. Here’s how I worked around that.” That’s refreshing. Thank you for saying that. Talk to us about how and where patriarchy comes into this whole equation with regard to women’s health, pain, and perfectionism. After the year we’ve had and the cycle of both social as well as governmental changes that are happening, this is something that’s interesting to people.
For those who don’t know, I took a definition of patriarchy, and that’s a social system in which men hold primary power and predominate in roles of political leadership, moral authority, social privilege, and control of the property. For reference, when I first heard this term, it sounded almost gimmicky to me. I ignored it for a while. I’ve had powerful female role models. My mom was super successful. I worked predominantly with women. I was like, “Patriarchy can’t possibly be affecting me.” I believe women can do whatever they want. I discovered more and more about it. I’ve learned that it affects all of us, men included. Men suffer from patriarchal values as much as women do.
There are very few men that benefit from the patriarchy. I want to make that clear that this is not just a female issue at all, but my patient population is mainly women. The patriarchy has embedded in our nervous systems and women’s nervous systems, particularly, that it is not safe to authentically be yourself. Having an opinion, stepping into a powerful role, being a woman in the public eye has historically been unsafe to the point that it can get you killed, and still can in places in this world. That is still an issue. Our nervous systems carry on. We know that things get passed down in our DNA and through belief patterns. We are at this weird place where all of a sudden, it is safe from a “we won’t get killed” standpoint for women to step into a role of power, but our nervous systems don’t know and don’t trust that yet. All of a sudden, we are women and we are having opinions, your nervous system is like, “What are you doing? You might get killed.” It can freak out, increase sensitivity, and make us more susceptible to chronic pain.
I love those connections between the sensitive nervous system, perfectionism, patriarchy. It’s like the 3Ps of chronic pain almost, or the 2Ps that lead to the third P of pain. What are some of the biggest mistakes people make when attempting to address their pain now that we know some of these important concepts that you’re starting to bring to light?
One of the biggest mistakes is that people think pain is simple or there’s going to be one thing that solves their pain. Even when I’m talking from this point of the patriarchy and how it affects our nervous system, that’s still only one component of what I’m working on with women. We know that pain is complex, and to treat it as anything other than complex is doing it a disservice. Often what I see is people drive too hard in one aspect. You see this as the most commonly seek out like a lot of passive care. They get a massage, acupuncture, chiropractic, even manual physical therapy coping, all these different modalities, but they’re all passive. It’s all in the same realm of bodywork, which are great and super valuable, but it’s only one component. You’ll see people drive too hard like the work through, “I need to strengthen, exercise and move,” which is incredibly important but still only one aspect.
There are the emotional side and this deep trauma side. You’ll even see some people who have done a lot of therapy, or even do a lot of energy work, and go more into the more energetic realm and emotional realm of it, but then they dismiss the movement or actual body works side. You have to address all the pieces that are contributing to it. There’s the nutrition component too, which is a whole different topic as well. Pain is complex. It’s not simple. It’s not going to be one thing that helps someone get over their chronic pain.
With regard to the energy component, people are going for energy therapy, energy releases, all sorts of different energetic therapy so to speak. Do you find that there’s a benefit for that for people, or does it become a slippery slope where it’s passive in some way? Unfortunately, it causes people to give up their self-efficacy with regard to their own ability to heal because anything can be a crutch with regard to healing.
I have personally experienced energy work that has taken away pain in the moment. I am a believer in it, and it is still one component. If you’re not addressing the underlying reasons that caused that energy or that pain to happen in the first place, it’s going to come back. It becomes the same thing as going to a chiropractor who was fixing an alignment. It keeps coming back. Maybe you do get relief, but you’re not addressing the root cause. I see this a lot with energy work.
How do you begin to approach the topic of perfectionism and patriarchy? It sounds like they are a bi-directional relationship. How do you approach that topic with new patients or maybe a patient you’ve seen for a while, they are starting to hear that this is a part of their pain experience, and something that needs to be discussed and talk through with them?
It is all person dependent, but with a lot of the stuff that I’ve learned through your course, starting with the values work, it tells me a lot about where someone’s mindset is. A lot of times in trying to figure out someone’s values, you’ll see people struggle with even understanding what their own values are. I’ll have women who are starting to talk about these values. They acknowledge it. I had someone who is openly admitting like, “I have these values. I care what other people think about me. I need to succeed. I need to do this.” They’ll recognize that it’s not quite theirs, but they’re so attached to it. I don’t always bring it up right away at all. It’s working through it in different sessions, but then I have some great resources and educational pieces that I use to start to integrate like, how can we get to the root of what you want, and understanding that there can be a lot of resistance and fear to access that place. Sometimes we have to work through the resistance, fear, and make the nervous system feel safe before we can ever even uncover someone’s true values.
With regard to professionals who are treating chronic pain, where does perfectionism show up in our group, in our inner circle with regard to perfectionism and treating chronic pain? How does that start to connect and overlap with some of the work you’ve done with Acceptance and Commitment Therapy?
The biggest thing is exactly what I was doing when I first started out. It’s having way too high expectations of, “In this session, I’m going to do this one technique that’s going to get rid of this person’s pain,” when really the outcome might not be to affect the pain at first. Hopefully, yes, along the road. I usually see a decrease in pain, but it’s rarely going to be the first thing that happens. I see clinicians get stuck on, “How do I get this person’s pain down? How do I make this immediate effect in whatever functional movement?” If they can’t, they get anxious about it. That anxiousness can transfer to the patient because then the patient picks up on that. That can increase the patient’s nervous system sensitivity because then they’re like, “Something is so wrong with me that this expert can’t fix me. I’m really screwed up,” I am guilty as charged with doing this early on. We almost unintentionally increase our patient’s pain by making them feel even more broken.
Do you think we enter PT school with that concept in our minds? Is it something that’s reinforced during PT school? Is it when you get out of school there is pressure from employers and jobs to help our patients? A lot of what is identified as successful therapy is the elimination of pain, which is ironic because we don’t have any good research that there’s anyone out there who can snap their fingers and make the pain go away.
It goes back to that whole patriarchial belief set of this perfectionism. Everything that you said contributes in some way. For example, you’ll have an expert on this show, and chances are they can do some amazing techniques that do help people rapidly. We only get to hear about the successes most of the times, and people aren’t as open about the failures or other patients that they had that walked out of their clinic that didn’t feel better right away. We’re exposed to this culture where we only talk about the wins, and even the fact that I’m using this language of “that’s the only win” is part of the problem. You see that this feeds into everything. Just because we didn’t make a patient feel better doesn’t mean it was a failure. It’s gaining more information. I had that pressure on me in my first job. It was like, “This is a cash payment. People are paying a lot of money to see you.” It comes from many aspects.
I’ve thought about this a little bit with regard to what we’re talking about. The profession of physical therapy didn’t start out as sports and orthopedics. It started out more in rehabilitation, but at the boom of PT, which was in the mid to late ‘90s, there was a big emphasis on sports physical therapy. It runs parallel with sports where there’s a toughness when the post-surgical protocols that athletes benefit from and other people benefit from even those were accelerated. When ACL protocol first came out, it was nine months. You had nine months of physical therapy with the patient, then over time, these protocols have “accelerated” to four months and even three months and etc.
We look at this, and we say, “What are we doing here? What are we doing as professionals? Are we giving people the time and the space they need to heal, or are we accelerating things and pretending we can cure all these things for the sake of an insurance company so we can save them money? Is that our egos?” We now have “DPTs.” These are all interesting topics that I think about with regard to, how do we now position ourselves as the profession that is perhaps best suited for treating the myriad of pain and all the multimodalities that we have to deliver and help people with and the behavior change with regard to pain? Some of my own experience when I think back as a man, so to speak, that’s where patriarchy shows up. You mentioned that patriarchy doesn’t just adversely impact women, it impacts others as well. Can you talk about others besides women who it might impact?
A huge thing where it impacts men, where you see the difference between how it impacts women versus men, is for men it makes it that if you’re not this manly man, all of a sudden, that makes you worthless. The patriarchy affects everyone by being like, if you don’t meet this one ridiculous standard, you aren’t worth as much as a person. That affects men very much. That’s where you see so much mental health issues. This goes into a much bigger topic with men and suppressing emotions because crying as a man is looked down upon. That must mean you are weak. That’s ridiculous. Showing anger as a woman, then something is wrong with you because as a woman, you’re not supposed to be angry.
We have this whole culture of suppressing emotions which is unhealthy as we are now seeing in many different ways. Even what you were speaking to about this need to be like, “How do we get rid of the pain as fast as possible?” It shows our whole society’s discomfort with being uncomfortable. There are emotions that are uncomfortable, there’s pain that’s uncomfortable, and it’s all part of the human experience. I feel like our focus should be like, “How do we get better at being uncomfortable because that’s what makes life interesting and fun?
This happens with patients and in our own personal lives. When someone sees tears, there’s no way that tears can possibly relate to triumph. That tears have to equal trauma. That’s not what’s happening in many cases, it’s the opposite. It’s like, “Here’s what’s being processed. Here’s the opening up that’s happening.” Now, there’s an opportunity there to go with that. Some of it is uncomfortable for both us as practitioners and for the people themselves, but there’s an opening in that whole process there to move things forward. With all this talk of the sensitive nervous system, and more in the work I’m doing, I’m talking about let’s move away from pain relief 100% and let’s look at life rescue before values. Why is it still hard for people to turn toward their pain and listen to what the message that pain is sending them?
It’s because we’ve been trained not to listen to our bodies from a very young age. A common example I give is if the kid falls down and gets hurt, the parents are uncomfortable with their kid crying and being hurt. They’re like, “It’s okay,” when they’re not okay. They got hurt. The emphasis ideally can be like, “You got hurt. That hurts when you fall and skin your knee. Cry and let it out. Let’s process that. That’s normal.” The other example is around food. We’re often taught to clear our plates. Even if a kid’s not hungry anymore, their body is telling them that they’re not hungry, “You have to clear your plate. You need to finish what you put on.”
We override these signals that our body is giving us. Another thing is going to the bathroom. If you’re in school, you might only have designated bathroom breaks. You have to override your body’s natural signal. It’s trying to talk to you and you’re not listening to it. If you want to cry but you’re a boy, and you’ve been taught that boys don’t cry, it teaches us to suppress these signals. Often these signals our bodies are giving us are associated as negative, when it’s a positive thing. What makes it tricky is not just learning a new skill, it’s unlearning something that we’ve been taught. That unlearning to me is where the fun lies and working with people, but it’s the challenging part because in unlearning, we have to expose a lot of our deep beliefs, mindsets, thought processes and uncomfortable things. As a culture, we’re not great at being uncomfortable. That’s another reason why it’s hard.
Tell us what your practice looks like and the components of care that you include when you work with women?
My whole message with women and my whole goal is to help women when they see pain as a messenger and as a guide to living their best lives, and using it to their advantage. It’s about shifting the relationship with pain because pain is always trying to tell us something. Sometimes, we have to decipher that and then work through a whole lot of layers to be able to do that. I’m all virtual and I have a lot of sessions. I always have a mix of movement sessions because the movement piece is important. It can look a little bit different for everybody depending on what they need, but everything is going to be individualized to what the person needs. We’ll leave it at that.
I have coaching sessions or more education sessions, and digging into a lot of the things that we’ve talked about already on this show. We’re helping women uncover some of these beliefs that are either subconsciously or consciously there, and working through them, changing them in a way that helps them live authentically themselves, and uncovering where some beliefs aren’t necessarily theirs. That’s one of the biggest things. I’m undergoing a certification program through Dr. Valerie Rein. She wrote a book called Patriarchy Stress Disorder. One of the biggest things that blew my mind in her course is there are a lot of things that we hold onto and that our body holds onto that aren’t ours to process in the first place and aren’t ours to heal. Helping women decipher between that and that’s a lot of somatic work. That can all be done virtually. I’m helping address it, and I also have my nutritional therapy certification. If there is a nutrition component, we work on that. It’s a full-spectrum approach. I can do everything but the hands-on bodywork. Even a lot of that, I can show you how to do on yourself. It’s like a one-stop chronic pain shop.
You’re using all your physical therapy skills, some essential coaching and life skills, some Acceptance and Commitment Therapy skills. It sounds like unique things that you’ve picked up along the way, both through life experience, then through your own research, and nutrition which you mentioned. It’s a biopsychosocial approach. What does a typical evaluation session look like? How long is that? What does it look like after that?
My evaluation is usually going to be around 90 minutes, sometimes it goes longer to two hours depending on the person. I am almost always working in packages for people. I always have consults beforehand to make sure we’re designing a package that’s right for the person. Since we know, a lot of the women I work with have tried everything they’ve been paying for ten-plus years. Oftentimes, it’s along the lines of a six-month package, and sometimes there are shorter packages. It depends if everything is individualized to the person because the pain is so individual.
Share with us a success story of one of your past clients. What was the transition like from where they began and where they ended up?
Someone who comes to mind, I’ll change her name to Bridget. She is struggling with a typical sciatic pain, and a recurrence of it has popped up again. She has three-year-old twins. She was unable to care for them. She had trouble giving them bath, lifting them up, and things like that. She was also very high up in her career and loved her job. She was working 50 hours a week, and also doing most of the household chores. She had a lot on her plate. Working with her, we uncovered a lot more to her back pain and why it was reoccurring from an emotional standpoint. We also worked on a lot of things from a movement perspective and strengthening perspective. We gave her short-term pain relief, but then I worked with her on how do we prevent this from coming back.
Short-term pain relief is sometimes easy. It’s the how do we prevent this from coming back piece that gets missed a lot in clinics when you’re trying to get people out the door. We worked into that long-term component. In the long-term, she had it. It was a whole family approach of getting her husband involved, talking with her boss, making her demands much more realistic. Her job ended up hiring another person to help her because what she did was important. She loved it, but she was taking on the role of two people and getting a lot more support in her life. At the end of it, she was much happier in her position, and was working at a much more reasonable amount. I’m trying to think if I might be mistaken, but I’m sure she ended up getting a raise in all of these, even working less because her company realized how important she was and didn’t want to lose her. She was able to play with her kids, pick them up, and do all of that. It was awesome.
Andrea, how can people learn some of these skills with regard to the topics we’re talking about?
The biggest thing is to start small. When you’re thirsty, drink some water. When you have to pee, go pee, don’t put it off. When you feel pain, start acknowledging it by saying, “I hear you, shoulder. You’re hurting.” Little things like that, just by listening to your body, even if you don’t know quite what to do with some of the things. Starting to listen is going to start to build some of that trust and connection back with your body that it’s been longing for. Sometimes, it yells at you with pain if you’re not listening to it. Another great tool is basic body scan meditation. A lot of people have trouble feeling their bodies. It might take practice, and you can find one on YouTube for free. You know anything that goes through it. It’s a ten-minute one. It’s noticing what is there when you do the body scan and noticing without any judgment, without the need to change it from the aspect of, “I can start to listen and acknowledge what is there.” If somebody is ready then to go deeper and wants to learn how to start interpreting some of these things or discovering if there is something deeper that they can go on with this, then reach out to someone who can help you like me. There’s a lot of deeper work that can be done.
It’s been great talking to you about helping women with regard to perfectionism, patriarchy, and chronic pain, and how it relates to all the different physical and emotional aspects that we spoke about here. How can people learn more about you and follow your work?
I’m on Instagram @DrAndreaMoore, and then www.DrAndreaMoore.com. From my website, you can contact me, and my email is on there. You can schedule a consult. If you want to talk more, I offer free consultations. I’m happy to chat with anybody, or you can DM me on Instagram. I have a Facebook business page too, but Instagram and my website are the best places to find me.
Make sure to check out Andrea on Instagram, and you can go to her website. I want to thank her for joining us on the show. We are talking about this brand-new topic with regard to perfection, patriarchy, and pain. Make sure to share this episode out with your friends and family on social media. When you have a chance, hop on over to iTunes and give us a five-star review and say something nice. Share with me via email or tag me on Instagram @DrJoeTatta.
- Episode 209 – How To Use The Mind To Overcome Chronic Pain By Combining Pain Education, Mindfulness, And Acceptance And Commitment Therapy With Joe Tatta, PT, DPT
- Radical Relief: A Guide to Overcome Chronic Pain
- Patriarchy Stress Disorder
- iTunes – Healing Pain Podcast
- @DrJoeTatta – Instagram
- @DrAndreaMoore – Instagram
About Andrea Moore, PT, DPT, OCS, FNTP
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