Dr. Joshua Levitt on Real Solutions for Musculoskeletal Pain

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Katie: Hello, and welcome to the “Wellness Mama Podcast.” I’m Katie from wellnessmama.com and wellnesse.com. That’s wellness with an E on the top. And this podcast is all about actual options for orthopedic and musculoskeletal ache. And I’m right here with Dr. Josh Levitt, who attracts on the science of each standard and pure drugs, he’s a naturopathic physician that has a very advanced, distinctive strategy to coping with musculoskeletal ache and orthopedic ache. And he talks right now about his wide-ranging strategy to this and why it’s rather more than simply addressing the acute ache. And he talks about how he acquired began as a naturopathic physician, the sufferers he works with and his strategy to care, the foundation causes of ache, the mind-body connection that we will perceive by understanding issues like phantom limb ache, understanding irritation and the way it pertains to ache, and a lot extra. He’s additionally the founding father of upwellness.com, which is a brand new firm. I’ve been utilizing a few of their merchandise and actually having fun with them. And we contact so much on ache on this one, however he has experience in a variety of completely different areas. I feel you’ll study so much. So, let’s be a part of Dr. Josh. Dr. Josh, welcome. Thanks for being right here.

Josh: It is an actual deal with to be right here. Thank you for having me.

Katie: Well, I’m tremendous excited to delve into your space of experience, however earlier than we get there, I’ve a notice in my present notes that you’re a surfer. And I’m presently in the course of a tropical storm, which is the one time we now have good waves in our space. So after this podcast, I might be taking a few of my youngsters to log on in a hurricane. But I’ve a notice that when you have been gonna give a TED discuss, you’d speak about how browsing imitates life. So, I do know this might be a subject of its personal, however are you able to simply give us a pair excessive factors there, to start out off?

Josh: Yeah, completely. Well, keep protected on the market, and, sure, hurricane waves are the most effective waves. I do know it sounds loopy to folks, when everybody else is desirous to hunker down, surfers seize their boards and head exterior. I can completely relate to that. So have enjoyable and keep protected on the market. Yeah, completely. I imply, at some point, I’ll most likely sort of develop a complete discuss round this topic, browsing imitating life. Oh, my gosh, there’s a lot to say, proper? Probably some of the frequent issues that comes up in my medical follow is about stability, and browsing and surfers, I feel, are sort of just like the individuals who can be accused of getting actually good stability, proper? It’s a balance-intensive train, and so, you understand, we discuss so much about stability. And I’m positive, you understand, it’s a topic that comes up, work-life stability, marital stability, you understand, all these types of issues in stability and well being and wellness and conserving your self collectively.

And so, you understand, a surfer looks as if a great individual to speak to about that, proper? Well, it seems that in browsing, and I suppose it’s additionally true in life, there’s probably not something…there’s no static mounted level of stability, proper? Surfing is that this, like, ever motion, ever-fluid exercise that requires fixed form of evaluation of what’s taking place with the wave, along with your board, along with your physique, with the currents, and whatnot, after which readjusting. And so, the concept a surfer is at any level balanced is basically not true. Instead of being good at balancing, what surfers are good at is the efficient administration of imbalance, and I feel that these are two actually various things, proper?

So, when an individual’s browsing on a wave, the wave pitches, and you progress, after which it pitches the opposite approach, and you progress the opposite approach. And I’d argue that in life, this concept, there’s a pursuit that lots of people are on the lookout for, “I wanna find balance in my marriage, balance in my parenting, balance in my work, balance in my life.” And I sort of wanna inform people who, like, take it from a surfer. There’s no such factor. There’s no mounted level. It’s not like one thing balancing on one thing. It’s not static. We’re speaking a couple of fluid factor right here that’s life and work and relationships. And so, take it from a surfer, simply discover ways to successfully handle the imbalance, and also you’ll be significantly better off, in order that’s sort of like simply one of many bullet factors of my browsing imitates life discuss. And, sure, we may go on and on.

Katie: I really like that. I hope you truly try this as a chat at some point. And I agree with you. I’ve written about that too, that, like, stability is a shifting goal, and flexibility is rather more vital than discovering that mounted level usually.

Josh: Totally.

Katie: And additionally I wanna be certain that we now have a variety of time to delve into your space of experience, as a result of I feel that is one thing that impacts lots of people listening to some extent, and from what I’m seeing, it’s one thing that’s on the rise as effectively. But, to start out broad and sort of perceive how you bought right here, I’ve a notice that you just went to UCLA on a pre-med observe, and you then pivoted. So, are you able to stroll us by what precipitated that change for you?

Josh: Yeah, completely. And, sure, we’ll spend the vast majority of our time on our content material, as a result of ache, I feel there’s only a few individuals who don’t find out about that, and who’ve an expertise in some type or one other. Yeah. I used to be a type of youngsters who simply all the time wished to be a health care provider. So, it simply made sense. I studied neurophysiology at UCLA, and I had the great fortune to form of, like, change into pleasant with, due to parental relationships, with a variety of medical doctors at UCLA on the time, lots of whom, now, we’re speaking 25-plus years in the past, lots of whom discouraged me from drugs, profession in drugs that’s. They have been seeing the adjustments afoot. Many of them have truly come to move now, regarding insurance coverage corporations and massive pharma and all that form of stuff. Life as a health care provider, as they used to understand it, wasn’t nearly as good, and they also have been saying, you understand, “I don’t know if you wanna do this. You know, it’s gonna just get worse.”

So I took that recommendation and took off, for a yr. This is sort of what lots of people name a niche yr. After I completed UCLA, as an alternative of occurring to a graduate medical schooling, I simply took off for a yr, and this was me hair rising, you understand, hitchhiking and touring all over the world with a backpack, sleeping in youth hostels, sleeping on seashores, all that form of stuff. Anyway, the origin story, if you’ll, was, on this fateful flight, I used to be leaving from Israel, truly, the place I had been, and climbing round, and heading to Europe, Switzerland, actually, and I had a blister on the again of my foot simply from, you understand, a variety of strolling in sandals and never nice hygiene, I’ve to confess, on the time. Anyway, that blister acquired contaminated, and I knew sufficient to know that this was one thing critical. As I’m flying on this airplane, my leg is crimson. I’m getting a fever. It’s creeping up my leg. I had cellulitis, which is a really critical medical drawback. And so, I had the great fortune to have the ability to name in my folks again house. I acquired a prescription for antibiotics, known as right into a pharmacy in Zurich, Switzerland, and I hobbled my approach in there in a feverish state, and took antibiotics, which saved my life, or at very least, saved my leg.

And in that pharmacy, I noticed, like you’ll nonetheless see right now in lots of European pharmacies and locations all over the world, all these different medicines, proper? In addition to the antibiotics that I so desperately wanted on the time, I additionally noticed homeopathic medicines. I noticed natural teas, all this dietary stuff, nutritional vitamins, minerals, natural extracts and issues. And this was simply…possibly it’s as a result of I used to be sort of, like, you understand, in a febrile, hallucinating state or one thing, however this was actually, actually eye-opening to me. It’s like, wow, there’s this complete drugs that’s not antibiotics and surgical procedure and all of the stuff that I knew of, and that was the start. Like, right here I’m now. It’s sort of humorous to consider it this manner. I’m, like, the naturopathic physician who acquired his begin in a pharmacy the place I used to be choosing up a prescription for antibiotics, you understand, which I’m very grateful for, nevertheless it opened my eyes to a complete world of medication that I didn’t know existed, and has since change into my ardour, my profession, my life.

Katie: What a cool story. And I’ve the same factor, like, I positively have a tendency towards the pure facet of issues most frequently, however I additionally very firmly consider there’s a time and a spot for Western drugs. And I’ve been very grateful for the few occasions that it’s saved my life as effectively. I feel that’s an vital caveat to recollect on this dialog. So, what sort of sufferers are you seeing now in your workplace whenever you’re working with folks?

Josh: I’m glad that you just phrased it that approach, what sort of sufferers, as a result of I all the time like to consider this. Even in distinction to the mainstream or standard drugs that we’re speaking about, sure, we will be thankful for issues which have saved our lives, saved our limbs, however there’s additionally so much to be discovered from the pitfalls in Western drugs. And so, I feel the kind of affected person that I see, that’s sort of like a elementary query right here. So, for me, to start with, and most significantly, my sufferers are folks first, proper? I’ve by no means seen arthritis come strolling in my workplace, though I’ve seen a variety of circumstances of it. I’ve by no means seen most cancers or thyroid illness. It’s all the time been, to date right now, 20-plus years and counting, an individual with arthritis, an individual with coronary heart illness, an individual with most cancers, which I feel is a very vital distinction, and sadly usually will get misplaced in Western drugs.

We’re gonna speak about orthopedics and musculoskeletal ache, and it’s so frequent. I imply, anyone who’s been in a giant factory-like orthopedic workplace can know the sensation of, like, you’re “the knee in room six,” otherwise you’re the “hip in room seven.” And that’s actually irritating to folks as a result of they really feel like they’re simply their physique half, simply their illness, simply their gland, simply their sickness. And so, yeah, the primary a part of that reply is that they’re people. They’re sufferers. They’re individuals who have issues, in lots of circumstances, in my world, individuals who have ache. So, a variety of my follow was dedicated to the care of individuals with musculoskeletal ache, however definitely not solely. And then one other form of philosophical level there may be that if a health care provider like myself treats folks, then I deal with the issues that these folks have, which is, once more, very completely different than Western medical specialties. I stay in Connecticut, proper down the street from Yale. And at Yale, there’s hyper, hyper-focus on specialization, proper?

So, I’ve had, and I child you not, a affected person who had a really critical thumb drawback who went to see, not only a hand physician, however somebody who focuses on thumbs, which is sort of superb when you have a thumb drawback, nevertheless it’s fairly simple to really feel like that’s, the blinders are on, and all you’re being handled for is that drawback. So, my follow, though I had a reasonably important concentrate on orthopedics and musculoskeletal ache, was a follow that was just like the anti-specialty, or is a follow, it’s just like the anti-specialty. Whatever you bought, you’re a human. I understand how to deal with people, let’s go. And if we have to sort of transfer on down the road to higher specialization, then that’s high quality. But largely folks with musculoskeletal ache, and every part else, too, is my reply to that one.

Katie: I really like that reply as a result of, having been a affected person that I felt like was only a analysis when it got here to thyroid illness for a very long time, it’s actually superior to listen to a practitioner clarify it from that perspective. And it’s attention-grabbing in relation to ache as effectively, as a result of I really feel like as purposeful and naturopathic drugs have gotten extra well-known, individuals are trying into extra root trigger approaches now. So, as an example, by the top of my journey, I wasn’t only a thyroid affected person anymore. Most of the folks I used to be working with understood the intestine connection, understood how the physique works as a complete. But it looks as if with ache, particularly with joints, there’s nonetheless possibly, such as you stated, some blinders there, that whereas we will have a look at the whole-body strategy in different areas, it’s usually a temptation to go, “Oh, you have a knee problem,” and never have a look at the entire remainder of the physique, or not have a look at ache as being the entire remainder of the physique. And I’d guess that there’s nonetheless, in fact, going to be whole-body connections there. So, how do you strategy somebody who is available in with a posh case that possibly additionally has this musculoskeletal ache, or some sort of orthopedic subject?

Josh: Yeah. And that’s a terrific query. I imply, you possibly can completely relate. Patients with thyroid issues are form of generally form of simply siloed into endocrinology. And, yeah, ache is a very tough one, so much to say right here. I imply, definitely, if somebody twists their knee and tears their ACL snowboarding, they do, they’ve a knee drawback, proper? That’s fairly clear. But additionally they have ache, this mysterious sensation that we now have. I’d wish to form of share one thing that everyone can relate to, and I can relate to this, not personally, however professionally, having had sufferers who’ve suffered with this. There’s this drawback that we’ve all heard of most likely earlier than, it’s intriguing, known as phantom limb ache. This is in an individual who’s an amputee, who doesn’t have a limb. Maybe they misplaced it in an accident or damage or regardless of the case could also be, they usually nonetheless have ache in that limb, or itching or different kinds of sensations. Really tough to handle.

But it offers you this very attention-grabbing perspective whenever you simply give it some thought, proper? If an individual doesn’t have a foot, and their foot that they don’t have hurts, it’s fairly clear that the ache will not be within the foot, proper? It can’t be, as a result of there isn’t any foot, proper? So, right here we now have our skier that we simply talked about, who tore their ACL. Well, they’ve a knee. It’s simply sort of broken proper now, they usually have this ache, not in contrast to the ache that the phantom limb affected person has. Is the ache within the knee? Well, it definitely was generated by constructions within the knee, however the ache is perceived within the mind, proper? It’s actually a mind drawback, and, yeah, it has its origins in a trauma within the knee. And then the mind grabs a maintain of those alerts which might be coming from a traumatized space, after which tells the individual a narrative about it, after which there’s all these biochemical issues that occur, like irritation and muscle rigidity and fibrosis, and we will discuss all about that, in and round an space infiltrated with blood and cells to assist heal. And there’s this complete story, an emotional half.

So, ache, gosh, it’s actually one thing. And so, your query was how do I strategy a posh affected person with a ache dysfunction? Again, it goes again to that elementary philosophical standpoint. It’s an individual, proper? We have to grasp what tales they’ve round that ache, what it means to them, what they’re afraid of. A whole lot of occasions, there’s concern wrapped up in there. And then we now have to grasp vitamin, biomechanics, biochemistry, environmental drugs, together with toxicity and all the types of issues that purposeful and naturopathic medical doctors speak about, occult infections, and all the opposite issues that would make one thing that’s traumatized or injured and in any other case painful much more painful. And I feel that’s truly the important thing to debate right here is there’s so many individuals who’ve exaggerated reactions, be it irritation, or ache itself, past what their damage or trauma deserves, proper? And I feel there’s a lot room for serving to and therapeutic folks in that house, in that delta.

Katie: Yeah. So, let’s go deeper on that, as a result of having had a couple of joint accidents all through my life, it looks as if the mainstream mannequin of care is simply ache reduction and let it get higher, except a affected person wants surgical procedure. But it seems like from what you’re saying, there’s a variety of issues that might be performed otherwise and on completely different ranges that may actually change outcomes. So, let’s go deeper on that, and the way that might be performed otherwise.

Josh: Yeah, completely. And you’re proper. I imply, ache is taken into account now a significant signal, and, you understand, that was sort of an concept that wound up sort of being a giant drawback, as a result of it initiated or was a part of the initiation of the opioid disaster that we now have now, treating ache, managing ache, staying forward of ache, all that form of stuff. When the fact is the ache is a sign, proper? Pain is a sensation that we expertise, that our physique is telling us to alter our conduct. The most sort of primitive instance I can consider of that’s, like, in case your hand begins feeling actually, actually scorching as a result of it’s near a fireplace, the ache tells you that there’s one thing that should change, and that one thing is that you could transfer your hand away from the hearth, proper? That’s nice. And that works rather well. If you could have a thorn in your foot, you’ll limp to not press extra on that thorn, these types of issues. It’s a really primitive sort of response. And but, like, there’s all these tales that get wrapped up in it, and in addition, it will get enhanced or elevated by all of those underlying baseline elements like vitamin and whatnot.

So, the quick story of how…the genesis of any sort of ache syndrome, I like to consider, like, you get up in the course of the evening to go use the lavatory or one thing and smash your toe in opposition to the facet of the top desk there, toe will get crushed, proper? Some tissue will get broken within the space. Hopefully, you didn’t break a bone, however, you understand, there’s injury to the world. And it hurts. And then a complete bunch of issues begins to occur. Blood vessels opened up. Some tissue was broken. That tissue that was broken launched some chemical mediators from contained in the cells into the native bloodstream, after which the native bloodstream sort of acquired sense…has sensors for these sort of chemical compounds which might be telling you that you just’ve been traumatized in a roundabout way. And that kicks off this superior, extraordinarily advanced cascade of interactions involving cytokines and leukotrienes, prostaglandins, and issues which might be all these chemical alerts that inform your immune system, basically, your white blood cells and all these cleanup cells, to say, “Hey, there’s something going on in that toe. Get on down there and start to clean up the mess.”

So, that’s what occurs. The white blood cells infiltrate the world, and the cleanup crew begins. The level right here is that this inflammatory response, and we’ll get into irritation possibly even in additional element as we go alongside, is a mandatory a part of a therapeutic response. You have a, I consider a matrix of occasions that occurs, tissue damage, after which some ache, after which irritation, after which muscular rigidity across the space, some quantity of guarding, after which the therapeutic response. And irritation, which is a significant, main a part of the ache generator sort of cascade, is a significant goal, the place we see extreme response based mostly on the extent of the damage, proper? So, many individuals who don’t eat effectively, who’re uncovered to environmental toxins, and so on., will smash that very same toe in opposition to the top desk and see a higher inflammatory response. And so, the extent of ache, the extent of irritation in response to an damage is straight correlated with the underlying biochemical well being of the person. So, that’s how I take into consideration these musculoskeletal pains, whether or not they come from trauma, acute damage like a ski accident, or from an autoimmune illness or a degenerative course of like arthritis, it’s all the identical.

Katie: That is sensible. So, somebody with already the next diploma of irritation within the physique would have a heightened response to that acute irritation.

Josh: Absolutely. It doesn’t matter if it’s a mosquito chunk or if it’s an ACL tear in a snowboarding damage. An individual who’s more healthy will reply in a more healthy approach, with decreased ranges of irritation, a speedier therapeutic time, and so on. And that applies regardless of the trauma, whether or not it’s a degenerative arthropathy, whether or not it’s an autoimmune illness, or whether or not it’s an acute damage like a trauma.

Katie: And you additionally stated, like, that inflammatory response I’d guess truly serves an important function within the physique, in an acute sense, as a result of it’s releasing all of these signaling mechanisms, similar to there’s an inflammatory response post-exercise, that results in muscle progress. So that is…on the whole, irritation isn’t categorically a nasty factor, however you’re speaking about when we now have this systemically continual irritation that then makes all of those responses worse?

Josh: Absolutely. It’s both systemically continual or extreme in response to trauma or an infection or damage. And the way in which I like to consider it…and, sure, you’re proper. The inflammatory response is a elementary a part of form of human immunological reactions. If we didn’t have it, it might be lights out. It’s completely mandatory. And I feel, you understand, that is actually attention-grabbing. Perhaps you understand this, or possibly not, that irritation, it has a Latin root phrase, like so many medical phrases. Inflammo means to set ablaze. It means hearth. Inflammation is called after hearth. And very very like hearth, I imply, it’s a really aptly named course of. Fire is… Well, right here we’re, you understand, at a time when the world is burning up, particularly in California, you understand, these wildfires are so damaging. Fire is a large human development and elementary to our survival, proper? We use it to prepare dinner. We use it to remain heat. Harnessing hearth was one of many best achievements of humankind.

But hearth can also be extraordinarily damaging, maybe some of the damaging forces on the planet, and so irritation may be very a lot the identical. Like, we love a candlelit dinner, but when the candle catches the curtains on hearth, we now have a giant drawback, proper? So, irritation is called after hearth, and correctly so. It’s mandatory. It’s elementary. It’s truly essential to our survival, however an excessive amount of is a nasty deal. And an excessive amount of may be, like, a low-lying continual burn taking place on a regular basis, such as you talked about, a continual inflammatory state, or it may be that the comb is so dry, there’s simply a lot tinder on the market, that when one thing occurs, a trauma, an damage, a mosquito chunk, it flames up like that. And so, yeah, irritation is nice, however an excessive amount of will not be good.

Katie: And then it looks as if a variety of the primary line of strategy to, like an damage particularly, or to ache, is a few kind of anti-inflammatory ache treatment. But I’d guess since this isn’t addressing the foundation reason behind the opposite irritation, and there are unintended effects to a variety of these medicine, that may, in the long run, have a unfavourable impact, I’d guess?

Josh: Absolutely. I imply, yeah, the concept of suppressing irritation, you understand, sort of a superb achievement by way of drugs, but in addition not with out threat, proper? This is a elementary organic course of. I imply, you and I can each relate to this. If you could have any organic course of that’s form of been…that’s a part of sort of our system and who we’re, and also you simply willy-nilly suppress that system, there’s gonna be penalties to that, proper? You can’t simply get away with that eternally. And, sure, in fact, regardless of which approach you resolve to suppress irritation, whether or not it’s from prednisone or steroids like that, or from the extra frequent lessons of over-the-counter medicines, non-steroidal anti-inflammatory medicine, NSAIDs we name them, yeah, there’s gonna be a value to pay for that. So NSAIDs are, you understand, loaded with a complete host of unintended effects, and steroids are much more highly effective anti-inflammatories which have much more highly effective unintended effects.

So, the way in which that naturopathic medical doctors like to consider that is to assist the inflammatory course of, proper, reasonably than suppress it. And, I feel, that’s a very large distinction between the way in which I follow drugs and sort of purposeful integrative medical doctors’ practices, assist versus suppress. Of course, there’s a time for suppression. When an individual’s life is in danger or limbs are in danger, you understand, suppression may be mandatory. But if we take into consideration this as a hierarchical sort of strategy, if there are methods to assist a degenerative sort of joint ache kind of syndrome, reasonably than simply suppress, suppress, suppress irritation, the sufferers will virtually all the time be higher off in the long term.

Katie: That is sensible. And if ache is a messenger that’s telling us one thing in our mind, versus simply an acute response in a spot within the physique, it is sensible that simply suppressing that with out determining the foundation of it might be very counterproductive in the long run. And in my notes, you speak about a ache matrix, and sort of another strategy to dealing with this, which I’m beginning to sort of be capable of pull some items based mostly on what you’ve stated, however can we go into element on this, particularly for anybody who has, like, a continual ache like this that they’re making an attempt to work by?

Josh: Yeah, completely. And I feel that is form of elementary to the strategy. It’s one thing that advanced for me over time, sort of like a move chart or a course of, or perhaps a sample recognition, for me, within the workplace watching individuals who undergo, lots of them…and simply as a broad class, we’ll name it arthritis, proper? They have joints that damage. It may be their neck or their shoulders or their again or their elbows, wrists, you understand, hips, knees, wherever the case could also be. They get lumped into this class known as arthritis, and after we look rigorously at these folks, there’s a form of a sample that emerges over years of caring for them on this form of naturopathic sort of approach. First is, there’s one thing incorrect, proper? There’s one thing incorrect with the joint. It may be that the cartilage is thinned out. It may be that there’s bone spurring within the space. It may be {that a} disc within the cervical or lumbar backbone is thinner than it’s speculated to be or is bulging out in a single place or one other.

So there’s some structural integrity. In most circumstances of people that have these sorts of issues, there’s one thing that’s structurally compromised. Very usually, and I’d like to get into this extra later, that structural compromise is seen on X-ray or on MRI, and may be very usually the one factor that the medical doctors will inform the affected person is incorrect, proper? “Oh, we see this structural compromise. We see this bone spur. We see this disc thing. We see this joint space narrowing. There’s your problem,” proper? So, I’m right here to inform you that that isn’t all the time true. In truth, fairly often, it isn’t true. Structural drawback is simply part of the story, as a result of, from that structural drawback is that this complete matrix, this cascade of occasions that happens. The first, and one we began to only scratch the floor on somewhat bit, is when there may be structural issues, what does the physique do? Inflammatory response. Just like we described earlier than, this inflow of white blood cells, and there’s an inflammatory response. A wholesome inflammatory response, it’ll be graded based on the extent of structural trauma or structural integrity issues. But if an individual has these underlying elements, the inflammatory response may be extreme. So that’s the primary a part of the ache matrix after the structural drawback.

Structural drawback results in an inflammatory response, which might be wholesome and well-controlled, or it might be uncontrolled like a wildfire. And then from there, that irritation is a set off for ache. It’s, you understand, sort of an excellent system. You have a traumatized or structurally compromised space, you could have some irritation, you get a sign that it hurts. So you begin limping, otherwise you begin doing different sort of conduct change…postural adjustments, fairly often involving muscle rigidity. So, within the muscle mass adjoining to the disc, or within the muscle mass adjoining to the shoulder the place the rotator cuff is torn, or the knee or the hip or wherever the case could also be, it’s extraordinarily frequent for folks to have extreme quantities of muscular rigidity within the space the place there’s a structural drawback and a few irritation. We name this splinting or guarding. We’ve all skilled it earlier than. When one thing hurts, you sort of maintain on to it. Like, you don’t wanna transfer it extra, and it’s a really clever physique response, proper? And when one thing’s torn or broken, you maintain on to it tighter.

Well, similar to irritation, there are situations that can lead folks to carry tighter and maintain longer than they need to with that muscular rigidity, and if that muscular rigidity persists, you wind up having muscular rigidity as a brand new ache generator, proper? So, right here we now have a structurally compromised disc, some irritation within the space of the disc, now muscle rigidity within the muscle mass throughout that disc, and now issues are actually beginning to damage, proper? And then, this persists, and right here we go, the final part of the matrix, is when this persists lengthy sufficient, the muscle rigidity cuts off blood provide, and as that blood provide is minimize off, the tissue turns into, oh, gosh, extra gristly, like, much less tender. You know, when you consider a bit of meat, when you eat meat, you understand, there’s tender, and we sort of often like that. And then there’s, like, robust, and we don’t like that an excessive amount of, at the least most individuals don’t.

And in case your muscle mass are contracted and underneath rigidity, since you’re guarding them and holding for such a very long time, they will change into robust, and that toughness is the results of the buildup of fibrin, like a scar tissue within the space, that makes the musculature much less tender, much less juicy, if you’ll. And so, that, that I simply described, from structural compromise to irritation to muscle rigidity to fibrosis, that package deal is what hurts. And fairly often, whenever you deal with all of these different accent issues, particularly the irritation, muscle rigidity, and fibrosis, the structural drawback, it doesn’t matter a lot anymore. It’s not as large of a deal.

Katie: That is sensible. And you possibly can right me if I’m incorrect on this, however I’ve heard that the structural factor doesn’t all the time essentially line up with the ache response in somebody who’s in any other case wholesome as effectively. Like, as an example, I’ve heard of circumstances, folks having a bulging disc or ruptured disc and never experiencing any ache. Whereas conversely, they’ve a minor subject and be experiencing an incredible quantity of ache.

Josh: You’re 100% proper. It’s simply superb to me, Katie, that extra medical doctors don’t perceive this, or don’t even ask themselves that quite simple query that you just simply raised. Take a working example. Here’s an individual. I simply had a case like this final week. He has again ache. You know, it didn’t go away. He went to a health care provider. He acquired an MRI. And the MRI confirmed that he had a bulging disc, disc herniation in between L5 and S1 in his case. And then, he did some stuff. He did some PT. You know, possibly he took some treatment, no matter it was. It’s irrelevant. He did some stuff for a couple of weeks, and he acquired higher. So now his again doesn’t damage anymore. So, if…we’ll do a theoretical right here…we have been to shoot the MRI once more, he nonetheless has a disc herniation. So, you understand, he simply doesn’t have the ache anymore. And that is extraordinarily frequent. So, this has been effectively studied. Your level is well-taken, and also you’re completely spot-on on this one.

The presence of imaging abnormalities, like arthritic adjustments, joint house narrowing, disc bulges, degenerative adjustments of any type, don’t correlate with a stage of ache. There’s a lot of folks on the market who’ve all types of badness and yucky-looking stuff on MRIs, they usually really feel high quality. And there’s all types of people that have horrible ache whose MRIs and X-rays look regular. So we can’t correlate imaging findings, X-ray, MRI, CT scan, to a medical syndrome. It simply doesn’t work, and the rationale why is the ache matrix that I simply described. It’s not all the time…I don’t wanna say that the structural factor is irrelevant, as a result of it’s there. It’s an actual factor. There’s not speculated to be a disc herniation. But, if there’s extreme irritation, muscle rigidity, fibrosis in and round that space, that’s the distinction between that disc herniation hurting and never hurting. And that’s probably the most progressive ache management sort of protocol on the market proper now, is to disregard the imaging findings. They don’t matter as a lot as most individuals assume they do.

Katie: So, with that extra complete understanding of ache, what’s your strategy to treating that in a sort of a whole-person strategy, versus simply that acute trauma of the ache?

Josh: Yeah. So, and I feel speaking concerning the continual stuff is extra related. And I’ll begin truly by going again to one thing that we stated earlier than, which was concerning the expertise of the ache itself and the tales that we inform ourselves. You know, we have been simply speaking about how poorly imaging findings, X-rays and MRIs, correlate with ache, proper? But there are tons and much of people that get instructed by their radiologist or their orthopedist, and even proven these pictures, proper? They say, “Hey, look here. You can see. See how it’s bulging out right there. That’s a problem. See how this is asymmetrical, and there’s a narrowing over here.” And sufferers fairly often have this picture. They’re not radiologists, they don’t know what they’re taking a look at, however they’ve a picture seared into their mind by a health care provider, you understand, an authority determine, telling them that they’re damaged. That’s what that story actually is telling them.

In truth, the affected person I simply instructed you about was proven an image of an MRI with a bulging disc, and in his thoughts, he’s listening to this story from a radiologist, “Oh, your disc is bulging.” What he’s listening to and internalizing is that, “I’m broken, that my back is degenerated, that I’m a mess,” proper? “I’m falling apart.” And that may be a very unlucky casualty of that dialog. So, one of many first issues that I begin with is by telling folks, “Look, you’re not broken. There’s lots of people who have disc herniations like that, and they feel perfectly fine. In fact, you’re gonna feel perfectly fine in just a couple weeks, and you’re still gonna have that disc herniation. So, you’re not broken. You’re just hurting. So let’s start there,” proper? And that comes, you understand, as a terrific reduction to lots of people who actually really feel now that they’re damaged, so that they need to be cautious, they will’t run anymore, they will’t bike anymore, they will’t raise up their youngsters or one thing like that, for concern that their damaged again is gonna actually change into, you understand, a much bigger drawback. I feel Western drugs, mainstream drugs does an enormous disservice to sufferers sort of unintentionally, by telling them or implying that they’re broken, and it’s unlucky that that occurs. So, we begin there, attempt to, you understand, reverse that story, to alter the channel, so to talk.

And then, there’s this complete world of choices that change into accessible to folks, relying on the uniquenesses and the specifics of their very own case, that may, one, assist the well being of the broken connective tissues. So, these are issues that you understand about, Katie. These are issues that, like, are collagen, you understand, a variety of these connective tissues like cartilage have collagen at their base, and are shaped of compounds that you just’ve heard of earlier than, like glucosamine sulfate and chondroitin sulfate and methylsulfonylmethane, all these sulfur-containing amino acids which might be a part of the matrix, the fairly literal matrix of what we’re constructed out of. So, we use issues within the pure drugs world or within the dietary world to assist enhance the integrity of connective tissue, as a result of virtually all the time, whether or not it’s a disc or a bone or a muscle or a ligament or a tendon with connective tissue integrity issues, we attempt to assist that integrity. So that’s primary.

Number two is we attempt to assist that inflammatory course of, lower the quantity of extreme irritation, with out suppressing irritation, however simply supporting it. So meaning dietary adjustments. We can get deeper on that if we…you understand, there’s a lot. It’s mainly every part, actually, vitamin and way of life, that’s the distinction between a wholesome inflammatory response and an extreme one. So we go down that street with vitamin and dietary adjustments, and natural medicines as acceptable. And then if there may be muscle rigidity concerned, I wish to work on that as effectively. And that may be labored on additionally nutritionally and biomechanically, postural re-education, bodily remedy, energy, stretching, strengthening, set off level launch work, all these handbook issues that may be performed, lots of them with my very own fingers. And then relying on the chronicity, like how lengthy the issue has been occurring, and whether or not or not there’s proof of this scarification, you understand, particularly in outdated accidents, we attempt to do what we will to interrupt up that fibrosis that’s sort of the scar tissue, that toughness in a muscle or smooth tissues round an affected joint. And that’s the package deal.

Katie: And, yeah, it looks as if a way more complete strategy that may have constructive ripples. I imply, the concept of irritation and out-of-control irritation being a root of many issues has come up on this podcast fairly a bit. It makes full sense that it might have a tie-over into ache, and the plus facet right here being addressing all of these elements, even when you’re simply motivated initially by this acute ache, is gonna have such constructive spillover into so many different areas of life. Like, I really feel like altering that inflammatory response and getting it in a wholesome vary is gonna assist sleep, it’s gonna assist stress, it’s gonna assist digestion. Like, in fact, we all know the entire physique is linked.

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There’s lots of people on the market, particularly in relation to ache, I’m seeing lots of people utilizing several types of biohacking and stepping into a few of these, like, extra obscure, or simply sort of fringe concepts that I feel… My take is all the time there’s a time and a spot for lots of these issues, however I all the time like to inform folks, too, I feel 80% of it’s the belongings you’re doing every day, small habits, issues which might be free, your sleep, your stress, your meals, your motion. But I do additionally assume there generally is a time and a spot for these. But I’m curious your tackle that, as a result of a variety of these do appear to line up with musculoskeletal or bodily efficiency. So, do you employ any of these therapies, and in that case, how?

Josh: Yeah. I respect this query, and it’s a terrific one. And it’s virtually controversial somewhat bit. I do know that world very effectively, like, the well being and wellness world, you understand, and the attraction to the brand new…you employ the phrase fringe. You know, the “progressive” may be…you understand, we love shiny new objects on this nation, and that’s definitely no completely different on the planet of orthopedics and musculoskeletal ache. We additionally need to do not forget that ache is a large motivator. Like, folks hate ache. They don’t wanna be in ache, they usually’ll do something. They’ll spend some huge cash, they’ll do all types of loopy stuff to attempt to get out of ache. I feel it’s true that…you employ the phrase “biohacker,” which is variety of a complete neighborhood, a complete universe, actually, progressive medical stuff, may be very seductive, as a result of it makes these wild guarantees about this new science of injecting this or that.

And I utterly agree with you. I imply, I consider…and I’m gonna use somewhat allegory right here for a minute. If there’s a fly buzzing round in our kitchen, there’s a variety of completely different choices that we now have for that. And me, and I believe you may be comparable, I wish to attempt to, like, open up the window and see if I can get him out. You know, I don’t just like the fly being in there. It’s an issue that I’ve, however I’m gonna attempt to use, like, a peaceable resolution. And it generally works. There’s some dangers to it. It may be somewhat more durable. And then, I’d step it as much as, like, the rolled-up newspaper or the fly swatter, after which I’d step it up, though I most likely wouldn’t, only for the sake of my metaphor right here, to, like, a chemical spray, like Raid or one thing. You may spray that across the kitchen and kill it. And then, if it’s nonetheless not going away, we may pull out, like, a flamethrower, proper?

And the concept right here is that, like, there’s rising ranges of drive that might be used to deal with an issue, on this case, the fly drawback. I just like the least drive. That’s the way in which I love to do it. And if that doesn’t work, we step it up. And with every rising stage of drive, there may be rising ranges of toxicity or trauma to the kitchen, proper? Like, you pull out the flamethrower, there’s gonna be a giant mess. You’ll kill the fly actually successfully. And in orthopedics, we now have this on a regular basis, proper? We love surgical procedure. We love injections. We love prolotherapy, PRP, Lipogems, all of latest fancy stuff. And these may be nice, however they’re sort of up in that larger class, nearer to a flamethrower. So, if the case permits for it, there’s time, it’s not that extreme, then we begin with the mild stuff, the dietary adjustments, the life-style adjustments, posture, biomechanics, therapeutic massage, dietary remedy, natural remedy. That’s the opening the door or the window. And then we go up from there. And, yeah, there may be a time the place we’d like treatment or an injection of some type, and that is the place that biohacking universe begins up.

We had prolotherapy was one of many early introductions, which was the injection of sugar molecules to assist spur or improve the expansion of cartilage cells. And then that advanced, and lots of people now are doing PRP, platelet-rich plasma injections, the place we extract the platelets, which have progress elements in there, sort of a one-up to the outdated prolotherapy. And then up from there, we now have a bunch of fancy new peptides which might be accessible, or the extraction of fats, and injecting that into joints.

And you requested am I into that. Yeah. I’m into all of that. I feel that stuff is superb, and it’s superior, particularly if it comes earlier than the following big-ticket intervention, like, for instance, a joint substitute. But when you’re asking am I into that, like, proper out the gates? Absolutely not. I share your ideas. I wanna work with the open the door for the fly strategy first, dietary, natural, dietary, and sort of work my approach up that ladder, up that hierarchy. And so long as therapies are protected, and protected is each protected to the affected person, in fact, and in addition protected to their pocketbook… I feel there’s some huge cash to be made in a variety of these fancy interventions, too. So, “safe,” I’d use the time period very broadly. But if it’s cheap intervention, and it’s protected for the individual, and may be efficient earlier than pulling out the flamethrower, then yeah, let’s go, you understand. So that’s the place I’m at with biohacking and novel progressive therapies.

Katie: Yeah. It looks as if an vital sort of development of the depth of therapies there. That was a terrific analogy. And I’ve all the time heard it stated that folks solely change when the ache of staying the identical turns into higher than the ache of adjusting, and on this case, speaking about precise ache, it’s a beautiful trainer, to your level. And so, I’d guess for lots of people, you get to see them in an attention-grabbing level the place they’re hitting that threshold of it’s now extra painful to remain the identical, they’re prepared to alter, and also you’re in a position to then educate about all the methods by which they will try this, that even when they find yourself needing at some point a type of extra superior issues like surgical procedure, hopefully not, however their physique is gonna most likely be in a significantly better state to deal with surgical procedure, or deal with no matter they want at some point, than if that they had not addressed these issues. Because as you have been speaking about this, I’m imagining, you understand, if somebody’s having…we’ve talked concerning the inflammatory connection right here and all of the layers of this. If somebody is in that state, going by surgical procedure is one other stress on the physique, is creating extra irritation and tissue injury within the physique, so their restoration from that is also fairly tough in the event that they haven’t addressed these different elements.

Josh: Yeah, completely. It was so eloquent the way in which you simply described that, Katie. It’s so true. That’s the place individuals are, proper? That’s the precipice that they’re on, “This problem that I have is no longer acceptable to me.” And they’re prepared to do one thing about it, proper? And I feel the aim of the doctor, I imply, definitely, it’s not a approach I’ve ever actually considered my job, however it’s, to form of assess, like, “All right. Like, how problematic is this? What are you willing to do? What changes are you willing to make?” It’s definitely a dialogue that we all the time have, like, how a lot do you want your present weight loss plan? How a lot do you want your present inactive way of life? Or, in some circumstances, how a lot do you want that working that you just do, that’s simply messing up your knee? And I’ve had numerous people who I’ve needed to say, you understand, “I think it might be time to switch to a bicycle.” And it’s brutal. It’s a brutal actuality examine for them to need to assess, like, “Yeah. I’m on a precipice right here. I cannot deal with this hip situation anymore. I have to make a change.”

And, yeah, for some folks, meaning I’m able to have a surgeon minimize me open and take my outdated hip out and put a brand new one in. But there’s many…I’d say not…I don’t know if I wanna say most. In my follow, I’d say, you understand, a major majority of individuals can enhance their ache state, musculoskeletal ache, fairly dramatically with out resorting to the flamethrowers of the world. And that’s been…gosh, I imply, how rather more gratifying may a profession be, to have the ability to assist folks keep away from these sort of costly, scary interventions, and as an alternative use pure therapies? And, yeah, it’s unlucky that we now have to… It is. It’s very laborious to get folks to alter till there’s some purpose that nearly forces them. And, yeah, truly, in a variety of methods, makes my job simpler, proper? Here they’re. They’re able to go, you understand. So I simply assist usher them alongside that path.

Katie: And I’m positive it’s refreshing for them to work with somebody who will not be making an attempt to push them into the high-ticket, costly, and considerably drastic choices, but in addition deal with these root causes first. And I additionally assume, if we will shift…since you talked about the mindset a few occasions. I feel if we shift our mindset, we will have excessive gratitude when there’s ache, as a result of it’s an unbelievable trainer, and it will get our consideration, and we will study a lesson, and hopefully, we do, in a approach that has constructive results. Going ahead, I do know for me, I’ll, like, get weak for a second. A number of months in the past, I ended up, by a mixture of unusual and strange elements, getting rhabdo. Which will not be a factor that may usually have occurred to me, however I had had blood loss after which a sequence of issues that sort of compounded, and I acquired rhabdo. And the ache of that was sufficient to get my consideration. And positively, I used to be in a position to deal with some issues by that have and study classes about not pushing myself too laborious in sure areas, which have been vital to study.

But I feel if we reframe it, like, any sort of ache, even emotional ache, there’s a variety of metaphors there, turns into a terrific trainer if we let it. And if we don’t resist it, if we let it educate us, after which combine these habits and transfer ahead, and even for somebody who possibly doesn’t have a bulging disc or an ACL tear, and isn’t in acute ache, all of those belongings you’ve talked about, I’d guess, additionally improve our resilience if we’re injured or if we encounter ache, as a result of if we deal with all this stuff beforehand, it might appear to be we will deal with these issues higher in the event that they happen. Is that your expertise as effectively?

Josh: Yeah, completely. I imply, first, to your factor, and we received’t spend any extra time on it apart from me to say I hope it was a speedy and full restoration for you. It looks as if you’re doing simply high quality. So I hope that’s true. Yeah. The expertise of ache is a good trainer certainly, and I feel that we stay in a world, society, definitely within the healthcare universe, the place we wanna simply suppress it. We need nothing to do with it, proper? We wanna keep forward of it so to talk, medicate it away, and we’re shedding so much after we try this. Now, in fact, the ache is uncomfortable, proper? It’s uncomfortable for a purpose, and when an individual is ready to form of take a pair deep breaths and sort of go lean into that ache, that is what a variety of the mindfulness work spearheaded by Jon Kabat-Zinn and so many others, you understand, about utilizing cognitive conduct remedy and mindfulness as pertains to ache, may be superb, highly effective instruments that don’t contain any change, you understand, in vitamin, however have radical influence on the biochemistry and the entire form of neurochemistry of ache.

And completely, I feel, we have to take it for what it’s value. You know, completely, if it’s disabling or incapacitating, there’s instruments that we now have and we must always be thankful for to assist handle that. But, sure, it’s certainly a lesson, a trainer, and there’s all the time, and I’d say all the time, I imply, we don’t get to say that too usually in drugs, tales that we now have which might be borne of our personal experiences, that inform what our expertise is of that ache. And so, if, you understand, your life historical past tells a sure story, and you then come up in opposition to some sort of ache, you’ll take that ache expertise, and it’ll change into a part of your story. And which may make it damage kind of, relying on what your background is and what tales you’re telling your self about it. And so, I feel that as a part of a complete form of naturopathic administration to a ache syndrome, whether or not it’s a continual drawback or an acute drawback, is that the evaluation of that story, and making an attempt to assist folks discover methods to reframe it in a approach that makes it a constructive expertise for them in the end.

Katie: I really like that. And as we get near the top of our time, a couple of questions I like to ask, the primary being if there’s a e book or numerous books which have had a profound influence in your life, and in that case, what they’re and why?

Josh: Yeah. I do know your model with this query, and I really like this query. And my reply is a e book known as “Ferdinand the Bull.” And that may be a child’s e book that I’ve a couple of copies of. It was my favourite e book as a toddler, and it stays my favourite e book as an grownup. It’s the story of Ferdinand the bull, who acquired stung by a bee. Talk about ache. And it was proper at a time when all of the bullfight crew was coming in from Madrid to evaluate the bulls within the pasture, who was the largest, fiercest bull. He will get stung by a bee. He jumps up, he runs round loopy, they usually say, “Oh, we found our bull.” And they bring about Ferdinand the bull to go battle within the bullfights in Madrid, and all he ever needs to do is simply sit down in the course of the ring like he all the time did out within the pasture, and odor the flowers. He’s a peaceable, variety bull. He doesn’t wanna battle. And that’s all the time been my favourite e book, and it stays my favourite e book to today. It’s nearly, I don’t know, peace, smelling flowers, and non-violence. I simply love “Ferdinand the Bull.” So I respect the query and the reminiscences it evokes.

Katie: I really like that. That’s a brand new suggestion. I’ll put a hyperlink within the present notes for anybody who isn’t acquainted. And the place can folks discover you to continue to learn about your strategy and/or work with you in case you are taking new sufferers?

Josh: Thank you. Yeah. So, my follow, and proper now my follow is…I’m a busy individual, so my follow is full to new sufferers in the mean time. That can all the time change, relying on all types of various skilled and private life issues. My follow is right here in Hamden, Connecticut, and we now have 5 different medical doctors there as effectively. That’s a follow known as Whole Health in Hamden, Connecticut. And the web site for our follow is wholehealthct.com. You’ll see me there. I’m nonetheless there. I simply am at this precise second not accepting new sufferers proper now. I additionally am the medical director of an organization known as UpWellness, which is discovered at upwellness.com, U-P-W-E-L-L-N-E-S-S.com, UpWellness. And the brand of UpWellness is a wave. I instructed you initially I’m a surfer, and upwelling… This is an attention-grabbing little facet notice for you. UpWellness is the title of our firm, and our tagline known as “Nutrient-Rich Living.”

So, any surfer can relate to this, or anybody who’s swum within the ocean or a big physique of water. There’s this phenomena the place you hit a chilly patch, and a chilly patch is an upwelling, the place there’s this upwelling of chilly, nutrient-dense water from under, that replaces the nutrient-depleted water above, the place all of the organic exercise is, from the solar and the fish and whatnot. And so, that higher layer of water will get depleted, after which currents and whatnot will trigger this infusion from under of chilly water, and we expertise that as a chilly patch. But it’s additionally a nutrient-rich infusion, so therefore the title of our firm, UpWellness, “Nutrient-Rich Living,” and upwellness.com is the place folks will discover all of the merchandise that we create that assist folks with musculoskeletal ache and all method of different completely different issues, natural, dietary merchandise that me and my spouse Amanda Levitt, who’s additionally a naturopathic physician, formulated ourselves. So, that’s at upwellness.com.

Katie: I really like that. I’ll put that hyperlink as effectively. I had a few of your merchandise in my espresso this morning. It was scrumptious.

Josh: Great.

Katie: I’ll be certain that folks can discover these. And any parting recommendation to depart with the viewers right now?

Josh: Oh, gosh, you understand, we’re…I feel, sort of my tagline that I educate to my youngsters that I attempt to, you understand, most likely educate to myself as a lot as anyone, is simply to be variety to one another. We are in a very difficult time, you understand, and I don’t wanna get into it, all of the division that’s on the market. But I feel that there’s just a few elementary guidelines, and kindness might be on the prime of that checklist that would assist a variety of us, you understand, get alongside higher and clear up a number of the nice world issues if we simply stored kindness on the entrance of our minds. And past that, there’s one different factor, and I’ll share this with you, too, is that I’d encourage folks to search for methods to search out awe, A-W-E, you understand, once more, a surfer phrase. We use the phrase superior, proper, after which surfers possibly co-opted that phrase to explain waves, or maneuvers on waves.

But superior is one thing that, you understand, makes us really feel small, makes us really feel humble, makes us understand that the world is that this greater place that we’re part of. It’s the oneness. And it seems, closing notes right here, that scientists have studied all these completely different constructive feelings, and it seems that awe is an anti-inflammatory. If you expertise awe, it reduces ranges of IL-6 within the bloodstream greater than different constructive feelings, together with issues like pleasure and contentment and different constructive feelings. Awe is probably the most highly effective constructive emotion by way of anti-inflammatory results. So, be variety, and be superior.

Katie: I really like that tidbit. That’s actually nice to find out about awe, and I’d guess others like gratitude and pleasure are nonetheless useful. But that’s actually cool that they’ve truly studied that.

Josh: Yeah. They have. They studied that at Berkeley. Yeah. And they’re all useful, for positive, like gratitude, love, pleasure, all clearly useful, however whenever you have a look at IL-6 ranges, that is what they determined to evaluate, awe works the most effective. So go discover one thing superior.

Katie: And that brings us full circle to our start line with browsing, and I positively discovered so much right now. I’m grateful for the work that you just do. I do know we didn’t even get to essentially delve into your merchandise that a lot, however I’ll put a hyperlink within the present notes. I’m a giant fan, so I’ll put a hyperlink, folks can discover these. Everything we talked about might be at wellnessmama.fm. And Dr. Josh, thanks a lot in your time right now.

Josh: It was an actual pleasure, Katie. Thank you.

Katie: And thanks as all the time to you guys for listening and sharing your most precious assets, your time, power, and a focus with us right now. We’re each so grateful that you just did, and I hope that you’ll be a part of me once more on the following episode of the “Wellness Mama Podcast.”

If you’re having fun with these interviews, would you please take two minutes to depart a ranking or evaluation on iTunes for me? Doing this helps extra folks to search out the podcast, which suggests much more mothers and households may benefit from the data. I actually respect your time, and thanks as all the time for listening.