Hope for Healing with Charlie Merrill and Dr. John Stracks
Video: Watch the full session here →https://www.youtube.com/watch?v=OaCfNQISjOw
Introduction
Dr. John Stracks: Good evening, and welcome to Hope for Healing. I'm your host, Dr. John Stracks, joining you from my office here in Chicago. I'm a physician who focuses on the reduction and elimination of physical symptoms using mind-body medicine methods. If you'd like to learn more about my practice — my therapists and I do offer telehealth — my staff will be happy to talk with you. You can find more information about our services at www.cormendihealth.com
This Hope for Healing video series is one of many joint efforts between me and the team at Curable. For those who aren't yet Curable users, Curable is an amazing app offering science-backed techniques for chronic pain recovery. We've been working together for about six years now, and we created this series because we want to help people in pain understand the connection between what's happening in their lives and what's happening in their bodies.
Tonight my guest is Charlie Merrill, a physical therapist in Boulder, Colorado. Charlie is a strong proponent of working with the mind as well as the body to promote healing, and he believes we do people in pain a disservice by making the diagnosis about either the mind or the body instead of both. A big part of his mission is helping people reduce fear, get back on their feet, and return to their favorite activities. Charlie, thank you so much for joining me tonight on Hope for Healing.
Charlie Merrill: Thank you for having me, Dr. Stracks. I'm really excited to be here — really appreciate the opportunity. Can't wait to talk with you.
Dr. Stracks: Good — me too. I'm a big fan of your work, as you know. I want to start by talking about how you got into this work. First — what got you interested in physical therapy to begin with?
How Charlie Got Started in Physical Therapy
Charlie Merrill: I had some excellent mentors really early on, right out of college, who got me excited about the idea that I could use my hands to help fix the body — these manual therapy techniques. Because of those early mentors, it became a passion of mine. I saw clinicians doing amazing things and getting great outcomes. I always liked working with my hands, always liked science, and was really into anatomy, biomechanics, and physiology, so it made sense.
Then I had my own back injury, around that same time — a big herniated disc diagnosed on MRI, on my right side at L5-S1. The doctors wanted to do surgery. I was an aide and assistant in a physical therapy clinic at the time, so my journey to getting well again became: can I avoid surgery, and can I get pain-free and back to being an athlete? I had help and mentoring from physicians who were open to not doing surgery, and that's when I discovered Dr. Sarno — even before I went to PT school.
I mention that because I think it colored my early experience as a clinician, which I then carried through PT school and into clinical practice. I always had this background belief that the body can heal, and I always brought a hopeful, optimistic attitude into sessions with people because I'd seen it in myself. While I didn't discover the broader mind-body medicine world until much later, I think that attitude helped a lot of my clients more than my manual or technical skills.
Dr. Stracks: As we were talking about earlier, I also had my own health experiences and brought the mind-body connection with me into medical school. It's a very different perspective going through training already knowing about that connection, compared to most physicians — and probably most PTs — who are more focused purely on the physical aspect. I consider myself lucky that happened, so I could keep that perspective the whole way through, rather than learning it later after other material had already become ingrained. I'm really grateful for what I learned even before my formal training began.
So — you brought this understanding with you to PT school. Did you start practicing in this integrated way right away, once you graduated and opened your clinic?
Charlie Merrill: Not at all. I think I always had a bit of a psychologically informed mindset when treating people, but I was very much biomedical, biomechanical — I liked to say I could explain anything I found through biomechanics. And the reality is, if that made people feel safe and gave them a clear explanation, it probably helped, because it reduced fear. But I was very much in that strict biomechanics mindset. Looking back, I think I did have early therapeutic-alliance and listening skills that we know matter so much in this work — but I didn't have any of the clinical tools you and I understand today.
So I spent the first decade of my career working with athletes and people in pain, thinking I was somehow fixing the body — correcting a pelvic upslip, reducing tension in the quadratus lumborum, improving the firing of a muscle to change leg alignment. I did medical bike fitting for a long time, made custom orthotics for years. That first decade was really about learning that material well, before I realized I had to start unlearning a lot of it to actually help people in a meaningful, lasting way.
Charlie's Practice in Boulder
Dr. Stracks: Now that your practice has evolved, let's talk about what it looks like when someone comes to see you. You have your own practice in Boulder, correct? It's been there a while.
Charlie Merrill: Yes — I went through a number of smaller private-practice clinics, working as an orthopedic manual therapist, for a long time. Then I started my own practice once I realized insurance companies were squeezing physical therapy so much that we weren't able to do a great job. That forced me into a cash-based model where I could actually spend real time with people and feel good about the work. The last decade — my second decade in the field — has really been about that. The gift of it is that I get to create my own destiny, and I think that's what freed me up to really explore this work.
Introducing the Role of the Mind to New Patients
Dr. Stracks: Say someone calls and comes into your office with back pain or a shoulder issue — they don't know you from anyone, you're just the closest PT to their house. How do you start to explain the role of the mind to someone who assumes they're there for you to teach them the right stretches and then they're good to go?
Charlie Merrill: Great question. The most important thing I try to do — and try to teach other clinicians — is to come into every session with a beginner's mind, without assuming I already know what's going on. I start with a subjective history — really hearing the person's story. It's an emergent process, almost like an ADHD-style collection of evidence over 20 minutes or so. I'm already gathering evidence about what's going on, but I'm not assuming anything yet. Sometimes it's clear early on, or the person already has openness, and I'll dive right into talking about the role of the brain and nervous system in creating pain. But if someone has back or shoulder pain and doesn't know anything about this model, I might do my subjective history and go straight into my objective exam, because that rule-out process is so important for people, regardless of where they fall on the spectrum.
Dr. Stracks: I'm curious what you look for in a physical exam — especially since, in this era of telehealth, many listeners are getting care from people who've never actually examined them in person.
Charlie Merrill: My physical exam is still very orthopedically oriented — range of motion, muscle strength testing, positional assessment of the pelvis, neck, and spine — the things I've looked at my whole career. But I'm looking at them through a new lens. If the subjective history already gives me strong evidence — no injury when the pain started, a clear life stressor at onset, symptom behaviors that correlate with primary or brain/nervous-system-driven pain, certain personality traits — I go into the exam already wondering what I'm really going to find.
I still run through all my tests, and what I'm looking for at the end is: is there a clear biomechanical pattern I can treat, especially in the absence of those other findings? Or do I come away with a loose collection of normative findings that don't really coalesce into anything treatable? We know things like scoliosis, leg-length discrepancy, and short or weak muscles are often completely normative — but as a PT trained to medicalize those findings, I do a kind of mental wrestling: does this actually add up to something treatable through the body?
People tell me all the time that my evaluation — 20 to 30 minutes — is the most thorough they've ever had. "You left no stone unturned." I'm explaining as I go — neural tension, reflexes, sensation, a neurologic screen — talking through what I'm seeing, what I'm ruling out, what's normal, what looks great. That process itself starts reducing fear.
Dr. Stracks: Do you know the statistics on how long it takes a physician to interrupt a patient giving their history? I thought it was eight or ten seconds, but I think it's closer to seven.
Charlie Merrill: Seven seconds, yeah. I've had medical students shadow me and, after listening to a patient for maybe three minutes, they've said they'd never seen a physician listen that long before interrupting. It's just how the system tends to work.
Rethinking "Normal" Physical Exam Findings
Dr. Stracks: Let's go back to some of the findings you see that you consider normative, even though people are often told they're the problem — leg-length discrepancy, scoliosis, that kind of thing. What have you learned about those over time?
Charlie Merrill: Most of the time, the physical findings I see are completely normal — people have had them their whole lives. If you haven't had pain your whole life, why would that slight asymmetry suddenly be causing pain now? I love how the NOI Group, and Moseley and Butler, talk about how we grow like trees — organic, with different branches on either side. I have a cactus behind me that's crooked and broken and still perfectly healthy.
I also think of these findings as a result of pain rather than a cause of pain. We know pain affects how people move, how confident they are in their bodies, how they inhabit them — people become deconditioned. The brain, in a state of danger and fear, will reduce range of motion and take power away from muscles — inhibiting them rather than genuinely weakening them, often because it's simply less scary that way. That's how I orient most physical findings, unless someone's recovering from surgery or a real physical injury and needs support returning to a normal level of function. Otherwise, I tend to see it as the result of pain, not the cause — which is really backwards from how a lot of physical therapists, and physicians too, are trained.
Dr. Stracks: Right — physicians will often take whatever a person walks in with and, if they can draw a correlation, assign it causality, even if it's coincidental. I tell people the two big things I'm trying to determine when meeting someone new: is there a physical issue so significant that the person won't get better unless we treat it — a broken arm being the prototype — and is there anything potentially dangerous that we need to identify and treat, like a malignancy, an infection, or sometimes an autoimmune disease. Are there things you see in your exams that make you think "we need more of a physical approach here, at least at the start"?
Charlie Merrill: Certainly — if someone's in the early healing phase after a genuine injury, I can usually identify that. My wife broke her ankle two weeks ago rock climbing; you can see the phases of healing clearly. If I know a ligament reliably takes about 12 weeks to heal and someone's at week eight, I'll talk about the body and how well it's healing, and support what's helpful at that phase.
The other time I'll talk about the body directly is if someone is deconditioned or has adaptive changes that I feel are real barriers to moving again. I'm not necessarily changing the underlying issue by touching or manipulating it, but I'm giving input to the brain — hopefully in a way that reduces fear and feels safe to the nervous system — and the brain then creates change from the top down. We know emotions, safety, empathy, and compassion can be transmitted through the hands. I rely on that, especially early in the process, especially if people come in expecting hands-on work — I'm not going to flatly refuse, because that just increases fear.
Creating Safety in the Medical System
Dr. Stracks: Do you know our colleague David Hanscom, out in San Francisco?
Charlie Merrill: I do.
Dr. Stracks: He feels strongly that so much of the therapeutic value comes from creating a safe healing space — with you, with me, with him, with anyone in the health professions who can offer that kind of safety. Too often the opposite happens: people enter the medical system and become more and more afraid. I sometimes joke that I want to take my yoga-instructor colleagues and have them teach my physician colleagues how to say hello, ask how someone's doing, and say "I'm sorry you're not feeling well." It sounds simple, almost silly to say out loud, and yet I hear story after story of people being dismissed or treated poorly, rather than finding someone they feel they can partner with. It makes me sad that this isn't front and center in medical training.
Charlie Merrill: I agree — it's the foundation for everything else, and I think it's harder to teach than the technical, clinical skills we use for pain. Those emotional-intelligence skills are genuinely hard to learn and to teach, but they're foundational.
The Role of Imaging (MRIs, X-Rays, CT Scans)
Dr. Stracks: Do you ever look at imaging, or order it, after seeing someone? People often come to me having already had lots of CT scans, MRIs, and X-rays, sometimes wanting to know if they need more. How much stock do you put in what you see on imaging?
Charlie Merrill: Great question. I recently put together a document reviewing the research — not just on the spine, but the shoulder, knee, ankle, and foot — and there's a lot of research similar to that original spine study showing these findings are largely normative. I review a lot of people's scans, since they often arrive already loaded with them, and I correlate that — or don't — with my objective findings.
That's really important for me, to feel confident telling someone they're okay. Other times I refer people out and rely on physician partners — especially orthopedists — to look for something like a stress fracture in a runner, or to rule out something insidious. I think of it almost like a pyramid of evidence: at the bottom are RCTs and other research studies, and at the top is intuition — after 20 years, you develop a sense for when someone's an outlier, when a physical symptom or test result just isn't adding up to a clear biomechanical or nervous-system explanation. I sent someone to a cardiologist just this week. I send people to orthopedists all the time and rely on them to feed back what they find, because I need to feel confident as a clinician before helping someone go down this road. And there are times people genuinely need surgery — surgeons are very good at that, and I'm not closed off to it at all.
Dr. Stracks: Everyone in this field is trying to figure out how much weight to put on the mind side versus the body side. None of us are perfect, and it's not always either/or — we're trying to put together the best possible story to offer people the combination of therapies that gets them feeling well as soon as possible. A lot of people are in a gray area, and even physicians can't always give clarity. We tend to be trained to think in a binary way, but the people in the gray area are more challenging — you have to create enough openness that they're willing to wait and see. You can tell them, "this isn't an emergency, let's give it a month," and often, over the course of that month, they get much better.
Laura Burke's Story
Dr. Stracks: We interviewed a woman named Laura Burke back in December.
Charlie Merrill: Oh, I know Laura.
Dr. Stracks: Laura had 16 surgeries on her legs over a 30-year period. She was a participant in one of the Curable groups, and now she's a group leader. She once asked me, "I've had 16 surgeries — how is this relevant to me?" I gave her the answer I always give: there's always a physical component, always a psychological component, always an emotional component. In my experience — and probably yours — the psychological and emotional components are much larger parts of the whole picture than we'd assume, because intuitively we think it's all physical.
I told Laura to get started on the psychological and emotional side. I said, if it's 50/50 and you get 50% better that way, is that worth it to you? She ended up about 90% better. It freed her from needing to know exactly what was what — she could just do the work and see where it led. She'd already had plenty of physicians and clinicians look at her over the years and was confident nothing else was being missed. Once she stopped needing to decide ahead of time what was causing what, that's what allowed her to really move forward over the following three or four years.
Charlie Merrill: Amazing.
What Treatment Actually Looks Like
Dr. Stracks: How do you get started with people once you've done the evaluation — what do you work on in that first session, and over an ongoing course of three, four, or fifteen visits?
Charlie Merrill: I always come away with a short list of body-oriented things that might be important, and a list of brain/nervous-system/psychosocial factors that might be important. I present both to people in a way that reduces fear and normalizes them, showing that these are things we can address — a lot of people can even learn to do it themselves. Presenting both lists frees me up to talk very specifically about the psychosocial pieces when I feel those are the most important factors, which — even here in Boulder, one of the most active towns in the country, seeing a lot of athletic people early in their pain — is the case eight or nine times out of ten.
My psycho-education draws a lot from this mind-body world, but also from Moseley and Butler's excellent Explain Pain program. I've synthesized those, and I think of my delivery as an act of improvisation — I don't have a script. I share what feels right for that person, using metaphors relevant to their context — an athlete, a lawyer, whoever they are — because I want it to be a dialogue, not a lecture.
Dr. Stracks: What kinds of psychologically based assignments do you give people, alongside the more stereotypical PT homework like stretches or posture work?
Charlie Merrill: On the physical side, I frame it as a performance opportunity — removing barriers to getting back to running, sport, or whatever the person's goals are — and as a way of having a conversation with the nervous system to create change, so the brain will allow a hip or ankle to move more freely, or let an inhibited muscle come back online.
The first step in the broader process is helping people shift belief and understand what pain is and how it works. Then there's a phase of building an "evidence list" — I go over the evidence against the body being the problem (what I didn't find on exam, how good things actually look), and the evidence for brain and nervous system involvement, including symptom behavior. That leads to really interesting conversations, and it's often where any doubts or cognitive dissonance surface.
From there, people have options: working through the body and movement to reduce fear; doing somatic tracking — reconceptualizing what pain means and observing it with curiosity; tracking thoughts and feelings around pain, almost CBT-style; or going down a more emotional road — addressing fear of the pain itself, emotions about how long they've been in pain, their experience with the medical system, or other life stresses and past hard experiences that people would never normally connect to their pain. I lay out that menu and ask what resonates most for them that day, because not everyone wants to dive into emotions right away — especially someone who came in with plantar fasciitis just wanting it fixed. I might start with the body and gradually titrate in the other tools over time.
Dr. Stracks: That makes total sense — even when people understand or expect there's a mind component, it's often more comforting to start by addressing the physical side before moving into the deeper emotional work. You and I both learned about this early on from Dr. John Sarno, one of the true early pioneers in this field, who practiced in New York City in the 20th century. I spent some time with him while training, and what struck me most was that he was a physician who really thought like a psychologist. That's what you're describing — trained as a physical therapist, but with real skills on the psychological side that let people feel held in both places. That's a journey a lot of physical therapists new to this work have to build courage around over time.
Charlie Merrill: It really has been. Dr. Howard Schubiner had to give me permission to start doing this. I had a lot of fear about it at first, and had to gradually explore it — the more success I had, the more confident I got. Now I feel like if you're not treating those things, pain is genuinely outside your scope of practice. PTs ask me all the time, "Should I be doing this? Am I allowed?" And I tell them — if you don't, you really can't treat pain.
Someone recently told me they'd been told by someone in the medical system that they'd have pain for the rest of their lives.
Dr. Stracks: I said, with probably more edge than I should have, that anyone who tells someone that fundamentally doesn't understand pain. To think, in this day and age, that people still believe the nervous system doesn't have the ability to move toward health — it's just a fundamental misunderstanding of the science at this point.
Charlie Merrill: For sure. And I'll say — the deeper I get into the mind-body world outside my own profession, working with physicians I really respect, the more I realize there's a missed opportunity if we dismiss the body too quickly. People want to talk about the body, and they want to trust that we understand it. We can't just say "leave that behind, your body's fine, let's talk about your emotions." People still want a certain amount of that — we just have to be careful about how we do it. That's been its own journey for me: doing this with fidelity without scaring people.
Getting Back to Activity Safely
Dr. Stracks: One of the biggest questions I get is about returning to activity. A lot of people listening have stopped running, walking, sitting, working, or being with family. How do you help people get back to what they want to do, in a safe and effective way — especially knowing it's not a straight line, and setbacks happen along the way?
Charlie Merrill: Ruling out the body is always the first step, since it's hard to give people the green light to move without some confidence there. We know people tend to get worse when they stop moving altogether. So I go beyond "I need to get you moving again" to "movement is actually how you're going to get better — there's no reason to keep avoiding it."
Physical therapists have an advantage here: we can help people feel safe moving again in a really skilled way. Sometimes that means cueing a movement differently than they've tried before — a kind of brain trick that creates a new neural pathway through novelty, so the nervous system doesn't recognize it as dangerous. I might cue someone during a squat to hinge from the hips and drive the knees out — though I don't always frame it that way, since it can imply biomechanics matter more than they might. Often people are genuinely surprised: "Wow, I can do that." And they leave excited.
What I see is that when people try graded exposure using the old mindset — not really believing their body is okay — it tends not to go well. Doing the same graded exposure with a new belief and mindset can produce a completely different, much more successful outcome.
Dr. Stracks: And the follow-up to that — how do you coach someone through what feels like a setback? Say they have a great session, feel like they've had a breakthrough, then come back the next week saying they ran half a mile and were in bed for three days afterward.
Charlie Merrill: I lean on my Explain Pain training for that. There's great psycho-education around the idea that pain doesn't mean tissue damage, and that you actually have to move into some discomfort repeatedly to reinforce that you're safe. If you avoid pain entirely, you stay stuck. Similarly, a flare-up usually doesn't mean tissue damage — it means the nervous system tripped back into a danger-alarm state, and that's okay, we'll work through it.
I'm always trying to find the sweet spot, which is a moving target — people ask, "How far should I run the first time?" and honestly, I can only guess. I want to empower people to know some discomfort is normal, expected, and okay, and to become their own best barometer day to day — pushing less on a stressful day, and maybe surprising themselves on a good one.
Dr. Stracks: I'm a big Moseley-Butler fan too — the professional version of Explain Pain is fantastic. I like their model of identifying what you know you can do safely — walk around the block, or even just to the end of the driveway for some people — and what would clearly be too much, like running a marathon tomorrow. That gives you a sense of where you can push the edge, and you gradually raise the floor while keeping the ceiling in mind. There's still uncertainty — we can't guarantee someone won't push past the edge and end up back in bed for a week — but I try to normalize that too: you pushed harder than your body could handle in that moment, good for trying, it doesn't mean more damage, it's a temporary setback, and we keep slowly raising that range where you can safely be active.
Charlie Merrill: Exactly. I rely a lot on novelty, play, being in nature, and changing the rules to trick the brain and nervous system out of recognizing something as dangerous — since once a person has developed a conditioned response, pairing running with danger, for example, changing the context can shift the outcome. Our nervous systems are wired for novelty; if you just keep doing the same thing over and over, the brain may resist. So we get creative — different terrain, music, doing it with friends, mixing in a different sport for a while. Maybe that's what the brain wants.
Fibromyalgia, CRPS, and Wider-Ranging Pain Syndromes
Dr. Stracks: We've talked mostly about the stereotypical PT caseload — back, neck, shoulder, joint pain. Do you have much experience with wider-ranging pain syndromes, like fibromyalgia or CRPS, where it's not just one area, or where there's swelling, heat, and skin-color changes? Is that part of your practice?
Charlie Merrill: More and more, as I've gotten deeper into this work — though it's still not the majority of my practice. I do see people with chronic fatigue symptoms, fibromyalgia, or symptoms I've genuinely never seen before — the brain can produce any symptom it wants. People show up with the wildest presentations: a whole side of the body, a whole limb, or — often with cyclists — five different pain areas at once.
What's interesting is that swelling, as with CRPS, is one of the scariest symptoms for people, because unlike pain, which is invisible, swelling is something you can see and touch — so people assume something must be wrong. But swelling, like any symptom, is something the brain can turn on to get someone's attention. Catching this early, in the acute phase, really helps — being able to say, "I know this just started, but it doesn't necessarily mean you're injured; your brain is producing this." CRPS and fibromyalgia are definitely more challenging conditions to treat. I'd be curious about your experience with CRPS.
Dr. Stracks: There's growing evidence that the immune system and nervous system aren't really separate — they function more like one integrated system. Once you think of it that way, it makes more sense: a revved-up nervous system means a revved-up immune system. We have a patient with rheumatoid arthritis — a prototypical autoimmune disease — whose inflammation scores dropped by half through work with one of our psychologists, without any additional physical treatment, simply as her nervous system calmed down.
I also interviewed a patient about a year and a half ago who had a catastrophic leg fracture playing basketball in middle or high school, with significant swelling, redness, skin changes, and pain, and who's done phenomenally well over the years by understanding the nervous-system components behind those immune-related symptoms. When I see CRPS, I generally conceptualize it the same as any other pain presentation — sometimes more complicated, often with more in the background to work through — but the underlying process is the same. People who stick with calming their nervous system and building safety with movement can do really well. People get diagnosed with CRPS, go home, Google it, and think there's nothing they can do — but that's a fundamental misunderstanding of what we now know about the body.
Charlie Merrill: I love that you point out how all these systems communicate — musculoskeletal, nervous, endocrine, cardiovascular, immune — all different outputs the brain can influence. People talk about heart rate variability with conditions like POTS, which we now understand sit more on the mind-body spectrum. I've had people recover from CRPS in one body part, only to develop it in a new area — and even when we explain it through an autonomic or immune lens, there's still resistance, because it's genuinely hard to learn all this while you're in pain. There are often strong psychological and social layers underneath that need addressing — but mostly, it's just hard for people to believe they could be in that much pain and still get better.
Dr. Stracks: It's hard for practitioners to believe too. If you put a hundred physicians in this conversation, I think 98 or 99 would assume severe pain means something severely wrong in the body — but the research doesn't support that. Pain is one thing, tissue damage is another; there's overlap, but they're not the same. People experience plenty of pain without tissue damage, and plenty of tissue damage without pain. There's a lot of attachment, by clinicians and patients alike, to the old narrative. In my field, people talk a lot about breathing being "dysfunctional" or "broken" and needing intervention — but breathing is just a reflex; we're not consciously choosing how to breathe. Breathing is a manifestation of how safe the organism feels. Instead of pathologizing it, we can see it as the result of a nervous system in a state of alarm — and the vagus nerve, which people love to talk about, is ultimately controlled by the brain.
Dr. Stracks: Do you know Dr. Clauw up in Seattle at all — a colleague of Dr. Hanscom's? (Name as heard in the audio — worth verifying before publishing.) They put on a conference on the neuroscience of pain a couple of weeks ago, and I've been listening to the talks. He mentioned he doesn't use the word "stress" much with patients, because his research shows stress is the response to threat — threat is the primary issue, and stress is our appropriate response to feeling under siege. I like that model, because people get shamed for saying "I'm so stressed" or "I can't cope," when really the threat — the sense of danger — is where the problem develops.
Charlie Merrill: Interesting — people in my practice really don't like the word "fear." I think there's some leftover resistance, almost like that old "No Fear" marketing campaign from the '90s — people resist acknowledging fear, even though we're all living with it constantly. I like framing it as our life situation, rather than a diagnosis. I normalize it constantly — I talk about how it shows up for me, or with my wife two weeks into her broken ankle, where psychosocial factors are genuinely affecting her healing and pain. It's a normal human experience, not a label.
Teaching the Next Generation of Clinicians
Dr. Stracks: In the time we have left, I want to shift to the professional teaching you do — you and Dr. Schubiner have taught a series of classes together. How has that evolved, and when did you realize you wanted to make teaching part of your contribution to this field?
Charlie Merrill: Teaching is so meaningful to me — after working alone in my practice for so long, I felt an obligation to scale what I was doing and share it more broadly. The best way to learn something is to teach it, and a lot of my confidence has come from sharing this with other clinicians. I want to support colleagues in unlearning what they need to unlearn, and then learning these new skills to bring out into the world. I'm so grateful to do this with Dr. Schubiner and the confidence he brings into the room — I've learned so much from him. Our course includes an ongoing monthly consultation component where we discuss cases and review skills together, unlike the old "train and hope" model — a weekend course and then good luck. We both keep learning, and it's very rich.
Dr. Stracks: What kinds of misconceptions do people bring with them into your training?
Charlie Merrill: A lot of the clinicians who sign up already have some openness to these ideas — the majority of my colleagues are still very attached to the old model, and I see it on social media and YouTube all the time; those people aren't the ones signing up. But a lot of clinicians are having to unlearn a lot of what they learned in PT school. I've had students right out of school who are shocked at how different this way of thinking is from what they learned — and because they're already open, they move in this new direction quickly. Otherwise, people come in believing posture matters, that strength correlates with pain — which we know it doesn't — that mobility is a key factor. People have to come into the course with genuine openness to even start questioning whether that's true.
Dr. Stracks: We've hired three psychotherapists, and are working on a fourth, to join our practice over the past year — all here in our office because they're interested in crossing these boundaries too. It's interesting: psychotherapists learn about the mind, but many don't feel they have the right or the understanding to work on physical pain. It's incredible watching people from these different camps get brave enough to move into the other side — physical therapists asking about someone's life, psychotherapists getting comfortable asking about the body. One of the harder things for our therapists is learning to say, "I don't think you're injured, I don't think you need another exam — I think you can do more physically than you're worried you can."
Charlie Merrill: I have a dream of working with psychotherapists to build confidence in teaching movement — really showing people their body is okay, not just telling them. You and I have the advantage of being able to touch people, which is powerful — there's no substitute for putting your hands on someone and being able to say, "You're okay, there's nothing wrong here."
The Growth of This Field
Dr. Stracks: We sat on a panel together a month or two ago, and someone asked how quickly this field is expanding. What I said — and I believe it's true — is that 13 years ago, in 2009, Dr. Schubiner and I invited everyone we could find in this field to Ann Arbor, Michigan for a day to share ideas and get to know each other. Thirty people came, which felt amazing at the time, and Dr. Sarno joined by video from New York because he couldn't travel. Now Curable has a Facebook group for clinicians with literally thousands of people around the world. Interest has grown at least a hundredfold over the past decade, and all of us — you, Dr. Schubiner, Dr. Hanscom, and others — are still figuring out how to spread the word and get more people comfortable understanding the medical profession as integrated rather than siloed into specialties. It's an incredibly exciting time.
Charlie Merrill: It's a massive paradigm shift, and I hope it significantly interrupts the status quo. Watching this exponential growth is genuinely exciting. I think physical therapists are really well positioned to do this work as front-line providers — to catch it early, before it tips into chronicity, and tell someone with three-day-old back pain, or a runner with brand-new plantar fascia pain, that they don't have what their friends or doctors are telling them — they have pain for the psychosocial reasons we've been discussing. Catching that early, with the support of good physician colleagues, puts PTs in a great position to do this work going forward.
Dr. Stracks: We were recently approached by a young PT here in Chicago about potentially working with us. Despite being only a couple of years out of school, he described outcomes that surprised even the orthopedists he works with. He's clear that his manual skills aren't as developed yet, but he's good at sitting with people, asking questions, and making them feel safe — and he's getting results people haven't found elsewhere. I can't tell you how many times over the years I've heard from physical therapists, massage therapists, even hairdressers, who found they could talk with people, listen without judgment, and see what a difference that makes.
Charlie Merrill: I think these younger PTs, with a real beginner's mindset and less continuing-education reinforcement of the old way, actually have an advantage. The young clinicians who've come through our course have blown me away with how effective they are — and, importantly, because so many of my colleagues are burned out working in the old model, these newer clinicians are loving the work, because they're genuinely changing people's lives.
Dr. Stracks: I have a lot of hope for the generations coming up who are just more comfortable in the emotional world generally. It's not unusual for a young millennial or someone in Gen Z to hear about the mind-body connection and just say, "Well, obviously" — which gives me a lot of hope too.
Advice for People Who Feel Stuck
Dr. Stracks: Before we sign off — any last thoughts for people who've been working on this for a long time and either haven't made much progress, or aren't progressing as quickly as they'd like?
Charlie Merrill: I'm so glad you asked that right at the end. The most important thing is that this process isn't about working or trying harder — we have to support people in actually trying less hard sometimes, because the harder you push to make pain go away, the more paradoxical it becomes. Outcome independence is such a hard concept for both clinicians and patients. If someone's gone through Dr. Schubiner's book three times and filled it out three times, that repetition probably isn't what's going to help. As a PT, I've often been someone's third or fourth clinician, after other approaches haven't worked — which means we already know what hasn't worked, so we're not out of ideas. It's helpful to ask: what haven't you tried yet? What does your brain and nervous system need right now that we've missed? Let's simplify, boil it down, so it's less overwhelming, and help people really focus on doing one thing well.
Dr. Stracks: I especially like the idea of "trying softer" — that concept barely exists in our culture, and yet it's often exactly what people need. I've started learning a bit more about Acceptance and Commitment Therapy, and this idea that anything we don't want stays with us until we stop not wanting it — such a paradox. We do these things because they matter, not to make the pain disappear — because if we focus purely on making it disappear, it's often more likely to stick around.
Charlie Merrill: It's genuinely challenging, and everyone has slightly different needs — it's about showing people, over time, in their own context, what's going to work best for them. That problem-solving is actually my favorite part of the whole thing.
Dr. Stracks: Absolutely. And the last thing I'll say about feeling stuck: there are plenty of examples of people who get better quickly — people who read Dr. Schubiner's book and feel better within days. But there are also a lot of people who've genuinely struggled with these concepts for a long time. We've interviewed patients in this series who took three, five, or more years, with a very uneven path forward. People will often tell me, "I've been working on this for so long," and in the context of what I've seen, it's often not actually that long a timeframe.
Another thing I say to people a lot lately: when they ask, "When am I going to get better?", I tell them they're confusing "better" with a destination — better is a process. When we look at it that way, most people asking that question are already better than where they started, even if they're not yet where they want to be. If we miss that — if we skip over the process — we keep believing we're supposed to be somewhere we're not, and we miss all the progress people have actually made.
Charlie Merrill: Great point — let's look at how far you've come, instead of how far you have to go. That reframe matters. I also like this idea someone shared with me once: pain burns out like a campfire — you never notice the exact moment, it just happens gradually as you set new boundaries, create new patterns, remind yourself you're safe a thousand times, and start moving again with joy. It happens almost by accident, and one day you realize you never actually saw it happen. It's always in retrospect — "I haven't had a bad day in so long," or someone points out, "You've been talking for two hours and haven't mentioned your pain once." That's what getting better actually looks like.
Closing
Dr. Stracks: Any final thoughts before we sign off?
Charlie Merrill: We could talk about this all day — I know we've got a full week ahead, and here we are on a Saturday, and I could just keep talking with you. I'm so excited, I have so much energy for this — I want everyone to know about it. Shout it from the rooftops.
Dr. Stracks: Absolutely. Thank you so much — we'll end there for the evening. I really appreciate you being here and sharing your experience, wisdom, and examples with us this hour.
Charlie Merrill: You too, John — thank you for all the work you do, and for collaborating and sharing this with everyone.
Dr. Stracks: Absolutely — it's a village, isn't it?
Charlie Merrill: It is.
Dr. Stracks: Thank you to everyone listening, too. Every time we do this, I'm reminded how brave and cutting-edge so many people — literally millions around the world — are being, working on their symptoms this way instead of defaulting to outdated models of what pain and symptoms are about. As I mentioned earlier, we've expanded our telehealth options during and since COVID, so if you're interested in consulting with me or one of our staff members, visit www.doctorstracks.com and our team will follow up with the details you need. If you're interested in Charlie and his work, you can find him at MPerformance.com.
Charlie Merrill: Great — and I'll add that going forward, part of my work is also about supporting athletes and reaching the people who aren't yet hearing this message. That's really my next step — spreading this to new populations.
Dr. Stracks: And that's exactly who I treat in my practice too — so if you're an athlete, please reach out.
Charlie Merrill: Thanks, Dr. Stracks.
Dr. Stracks: Thanks, Charlie.
Cormendi Health specializes in mind-body medicine — helping patients understand and resolve chronic pain, fatigue, and other stress-related physical symptoms through neuroscience-based, evidence-informed treatment. To schedule an evaluation with Dr. John Stracks or another member of our team, visit our website.
Dr. John Stracks practices mind-body medicine via telehealth nationally and internationally. To learn more about working with Dr. Stracks or the Cormendi Health team, visit cormendihealth.com. You can find more interviews on the Cormendi Health YouTube page.