Beyond “Fixing the Body”: Dr. Jorge Esteves on Pain, Personhood, and the Real Power of Touch

What if your low back pain isn’t a “thing to fix,” but a whole story to understand? On this week’s Crackin’ Backs Podcast, Dr. Jorge Esteves—researcher, clinician, and pioneer in touch science—blows up the simple cause-and-effect myth in musculoskeletal care and replaces it with something far more human…and far more effective.

When pain is short, simple, and linear, a quick reassurance and a well-timed manual intervention can help a lot. But persistent pain? Different beast. Two people can have the same MRI and the same “disc bulge” yet live completely different recoveries. Why? Because pain isn’t just in tissues—it’s an experience shaped by our biology, history, beliefs, culture, and the meaning we attach to our symptoms.

Below are the most powerful insights from our conversation—built to inform, challenge, and give hope.

The Old Model Is Too Small

For decades, many clinicians were trained to hunt for “dysfunctions,” “subluxations,” or “somatic lesions,” then fix them. That works for straightforward, acute issues. But when pain persists, that mechanical lens gets blurry. People don’t arrive as backs or knees—they arrive as whole persons with priors (memories, expectations, fears) that shape what they feel now.

Pain Is an Experience—Not Just a Finding

Pain is built from inputs: past injuries, family stories, culture, anxiety, beliefs, Google searches (and now, yes, “Dr. AI”). Our nervous system is a prediction engine. If it expects danger (e.g., “bending forward will wreck my disc”), it tightens, guards, and confirms the fear. That’s the fear-avoidance loop: prior → prediction → tension → pain → stronger prior.

Clinically huge: Sometimes the reported “pain score” stays the same, yet the patient says, “I’m much better.” Function, confidence, and freedom can improve before numbers do.

Person-Centered ≠ “Talk More, Touch Less”

Esteves warns against two traps:
 

1. Swinging from “it’s all in the body” to “it’s all in the brain.”

2. Abandoning hands-on care in favor of lectures on neuroanatomy.

Reality: The body is our sensory landscape. Touch, movement, breath, and graded exposure change predictions in real time. Hands-on work isn’t just a “mechanical fix”—it’s a signal that can safely violate fearful expectations and open a window for the system to reset.

Smart Touch: What Great Clinicians Actually Do

“Smart touch” is not magical fingers—it’s skilled sensing, timing, and communication.
 

• Read the room (and the tissues). If anxiety spikes, soften pace, shift the conversation, bring in breath work or easy wins in movement.

• Create surprise safely. A gentle thrust, a new movement, or an unexpected ease can break the prediction of danger and unlock options.

• Co-regulate. Tone of voice, tempo, and presence matter. Touch is language. It can soothe, anchor, and reframe.
   

Touch Changes Physiology (Yes, Even in Preterm Infants)

Esteves’ research in neonatal care shows that gentle, affective touch can shift autonomic function—improving oxygen saturation and heart rate variability. If touch can shape physiology in babies with virtually no cognitive expectations, imagine its power when it’s paired with context, meaning, and trust in the clinic.

Tricks of the Predictive Brain: Use the Senses

The nervous system is highly “hackable” with multisensory input:
 

• Mirrors & movement: Two mirrors (front and back). If right side-bending hurts, watch yourself side-bend left—the brain “sees” the opposite and can soften its threat response.

• Graded exposures: Explore feared motions (like forward flexion) with relaxation instead of bracing. Show the system it can move and be safe.

• Conversation as intervention: Distract, re-focus, or visualize to change state while you treat.
   

Therapeutic Alliance: The Most Evidence-Backed “Technique”

Better relationships predict better outcomes. That starts before the table:
 

• Clear website and messaging, a welcoming front desk, and aligned expectations.

• In the room: listen, validate, set shared goals, and negotiate a plan that fits what matters to the person (not what’s convenient to the practitioner).
   

No one builds a perfect alliance with every patient. But honesty, empathy, and co-design go a long way.

From “Fixing” to “Gardening”

Esteves’ metaphor is gold: clinicians are landscape gardeners of the sensory world. We don’t “fix” people; we cultivate conditions for change—through touch, movement, breath, story, and environment—so the nervous system can update its model and choose new options.

That’s not soft. That’s science…and deeply human.

Practical Shifts You Can Use Today
 

• Stop chasing scary scans. Disc prolapses are common—even in people without pain. Use imaging to rule out danger, not to predict doom.

• Ask for the story. What matters most to the patient? What do they want back—walking with friends, riding the bike, picking up a grandkid? Build the plan around that.

• Touch with intent. Use hands-on care to signal safety, not just “put joints back.” Pair it with breathing, pacing, and small wins in movement.

• Train ease, not just strength. Relaxation + motion often unlocks more range than bracing and guarding.

• Measure what matters. Track function, confidence, and life participation—not only pain scores.
   

Why This Conversation Matters

Because millions live in protective mode long after tissues have healed. Because language, expectations, and hurried care can amplify fear. And because when clinicians combine smart touch, smart communication, and smart exposure, people don’t just feel better—they become better movers, thinkers, and doers.

Ready to Rethink Pain?

This episode is a masterclass for chiropractors, osteopaths, physios, and anyone navigating persistent pain. We go deeper into affective touch science, Bayesian brains, fear-avoidance, and practical strategies you can use tomorrow.

Watch the full conversation on YouTube: Watch on YouTube
Listen on your favorite player: Apple Podcasts • Spotify