Ever wondered how neuroscience and physical therapy intersect to tackle pain management? Unearth new learnings about your body's response to pain and its complex nature as we engage in a thought-provoking conversation with Dr. Natalia Sikaczowski , a passionate advocate for individualized patient treatment and founder of Symmetry Physical Therapy, and Dr Raymond Butts, an expert in investigating central mediated aspects of chronic pain. Explore the multifaceted dimensions of peripheral and central pain, and how the brain can be rewired to lower pain levels. From the mystery of immediate relief after spinal manipulation to the workings of McKenzie progression for extension-based work, the journey through the labyrinth of pain treatment is as complex as it is fascinating. Natalia and Raymond help us unravel the potential causes of pain, such as hypertonicity, hypoxia, and inflammation. Tune in to learn about the debate surrounding spine manipulation and the use of visual analog scales and numeric pain rating scores to effectively gauge pain. Timeline 3:03 What is pain? 7:42 By the joint? Muscle? Is it movement-based pain? 15:52 How is pain measured? Is the VAS good enough? 25:31 How does spinal manipulation diminish pain? 29:00 Why do patients feel good after chiropractic manipulation? 35:40 I think one of the biggest problems with physical therapy is we are not efficient – Drs. Butts and Sikaczowski; they want to feel better asap! 37:58 Disc, Facet, and Multifidus 39:39 Dry needling – what is it? How does it work? 42:07 What makes dry needling work is mechanotransduction 49:14 Blood flow restriction training – why PTs need to use it Dr. Natalia Sikaczowski, PT, DPT, CSCS, Cert. DN, BFR-C Dr. Natalia Sikaczowski founded Symmetry Physical Therapy in 2014 with the fundamental belief that patients should be treated on an individual basis. Dr. Natalia believes patients should be given a diverse array of treatment modalities and techniques, along with progressive and varied exercises and manual intervention to ensure maximum recovery. This all-encompassing approach, along with Dr. Natalia’s strong background in strength and conditioning has led to Symmetry’s successful treatment programs for patients looking to get back into sport, recover from injury, or beat chronic pain. Dr. Raymond Butts, PT, DPT, PhD, MS, FAAOMPT, Dip. Osteopractic, Cert. SMT, Cert. DN, MAACP(UK) Dr. Butts graduated with honors from the United States Military Academy at West Point with a Bachelor of Science in Human Factors Engineering and served as a 1 st Armored Division Army officer in Bosnia-Kosovo and Iraq. He also received a post-graduate, International Masters of  Neuroscience from the University of Tubingen, Germany, where he investigated central  mediated aspects of chronic pain with magnetoencephalography and fMRI. In addition, Dr.  Butts completed a Doctorate in Physical Therapy and a Doctorate of Philosophy in motor  rehabilitation from the University of South Carolina. His PhD thesis explored the use of transcranial magnetic and direct current stimulation to disinhibit the motor cortex and facilitate plasticity-dependent, motor recovery. He is one of 300 physical therapists in the U.S. to have earned a Diploma in Osteopractic. In 2022, he also became a Fellow of the American Academy of Orthopaedic Manual Physical Therapy, a title earned by only 2% of the physical therapy  profession. About the Show We cover all things related to sports science, nutrition, and performance. The Sports Science Dudes represent the opinions of the hosts and guests and are not the official opinions of the International Society of Sports Nutrition (ISSN), the Society for Sports Neuroscience, or Nova Southeastern University. The advice provided on this show should not be construe