#181 | No Time for Pain | Rick Olderman MSPT

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Rick Olderman, MSPT

• Author of "Fixing You" series
• Author of Pain Patterns
• www.rickolderman.com

This episode focuses on addressing chronic pain in older athletes using a comprehensive "systems thinking" approach to physical therapy. Rather than treating pain as an isolated symptom with a checklist of generic exercises, the discussion highlights the importance of diagnosing the underlying root causes through a simplified series of diagnostic tests. The conversation digs into how systemic bodily compensations hide underlying structural issues, how dysfunctional walking patterns directly trigger chronic lower body pain, and how most chronic back pain is mistreated by conventional physical therapy methods.

Key Discussion Points

• Immediate Pain Feedback: Effective physical therapy should yield almost immediate feedback and pain relief during testing if the correct underlying trigger is successfully targeted and adjusted.
• The "Spaghetti Against the Wall" Approach: Conventional physical therapy often hands patients a long list of general exercises without meaningful, personalized testing to determine the specific cause of pain.
• The Deception of Painless Damage: Our bodies are masterful "compensation machines," meaning structural degradation (visible on MRIs) can silently accumulate completely under the radar long before rising to the level of actual pain.
• Walking as a Keystone: Chronic pain tracking from the lower back all the way down to the feet is heavily tied to dysfunctional walking patterns; fixing the gait is fundamental to resolving this pain.
• The Over-Striding Error: A highly common walking issue involves throwing the foot too far out in front of the body with a heavy heel strike, which locks the knee and shuts off the gluteus maximus.
• Activating the Glutes: To properly engage the glutes and control pelvic/hip mechanics, walkers must focus on moving their entire body forward with the advancing foot, ensuring the knee stays automatically softened.
• The Three Body Systems and Patterns: The human frame operates on three distinct systems (movement, fascial, and reflex neurological) that get trapped in three fundamental problematic patterns: extension (too arched), flexion (too flat), or side-bending (uneven pelvis).
• The Back Crease Photo Test: A simple diagnostic test for a side-bending problem is having a photo taken of your bare back; a larger crease at the waist on one side indicates an uneven pelvis and rib cage, which typically aligns with the side of sciatic or SI joint pain.
• The Prevalence of Extension Problems: Roughly 99% of patients with chronic back pain suffer from an extension problem (an over-arched back), which is easily identified if back pain worsens when laying flat with straight legs or standing.
• The Flaw in Standard Back Care: Most traditional physical therapy methods treat chronic back pain by prescribing back-arching and prone press-up exercises, which actually worsen pain for 99% of chronic patients because it reinforces their existing extension problem.