Dr. Joshua Levitt on Actual Options for Musculoskeletal Ache

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Katie: Good day, and welcome to the “Wellness Mama Podcast.” I’m Katie from wellnessmama.com and wellnesse.com. That’s wellness with an E on the tip. 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 typical and pure drugs, he’s a naturopathic physician that has a extremely advanced, distinctive strategy to coping with musculoskeletal ache and orthopedic ache. And he talks right this moment about his wide-ranging strategy to this and why it’s far more than simply addressing the acute ache. And he talks about how he obtained 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 are able to 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 rather a lot on ache on this one, however he has experience in a number of completely different areas. I believe you’ll study rather a lot. So, let’s be a part of Dr. Josh. Dr. Josh, welcome. Thanks for being right here.

Josh: It’s a actual deal with to be right here. Thanks for having me.

Katie: Effectively, I’m tremendous excited to delve into your space of experience, however earlier than we get there, I’ve a observe in my present notes that you’re a surfer. And I’m at present 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. However I’ve a observe that in case you have been gonna give a TED discuss, you’d discuss 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. Effectively, keep protected on the market, and, sure, hurricane waves are the most effective waves. I do know it sounds loopy to individuals, when everybody else is eager to hunker down, surfers seize their boards and head outdoors. I can completely relate to that. So have enjoyable and keep protected on the market. Yeah, completely. I imply, sooner or later, I’ll most likely type of develop an entire discuss round this topic, browsing imitating life. Oh, my gosh, there’s a lot to say, proper? In all probability probably the most widespread issues that comes up in my medical apply is about stability, and browsing and surfers, I believe, are type of just like the individuals who can be accused of getting actually good stability, proper? It’s a balance-intensive train, and so, , we discuss rather a lot about stability. And I’m certain, , it’s a topic that comes up, work-life stability, marital stability, , all these kinds of issues in stability and well being and wellness and holding your self collectively.

And so, , a surfer looks as if a very good individual to speak to about that, proper? Effectively, 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? Browsing is that this, like, ever motion, ever-fluid exercise that requires fixed form of evaluation of what’s taking place with the wave, together with your board, together with your physique, with the currents, and whatnot, after which readjusting. And so, the concept that a surfer is at any level balanced is de facto not true. As a substitute of being good at balancing, what surfers are good at is the efficient administration of imbalance, and I believe 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 method, and you progress the opposite method. And I might argue that in life, this concept, there’s a pursuit that lots of people are searching for, “I wanna discover stability in my marriage, stability in my parenting, stability in my work, stability in my life.” And I type of wanna inform folks that, 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 few 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 type 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 really try this as a chat sooner or later. And I agree with you. I’ve written about that too, that, like, stability is a shifting goal, and adaptableness is far more essential than discovering that mounted level usually.

Josh: Completely.

Katie: And likewise I wanna be certain that we now have a number of time to delve into your space of experience, as a result of I believe 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 properly. However, to start out broad and type of perceive how you bought right here, I’ve a observe that you simply went to UCLA on a pre-med observe, and you then pivoted. So, are you able to stroll us by what prompted 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 believe there’s only a few individuals who don’t find out about that, and who’ve an expertise in some kind or one other. Yeah. I used to be a kind of youngsters who simply at all times needed 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, grow to be pleasant with, due to parental relationships, with a number of docs at UCLA on the time, a lot of whom, now, we’re speaking 25-plus years in the past, a lot of whom discouraged me from drugs, profession in drugs that’s. They have been seeing the modifications afoot. A lot of them have really come to cross now, referring to insurance coverage firms 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, , “I don’t know in case you wanna do that. You already know, it’s gonna simply worsen.”

So I took that recommendation and took off, for a 12 months. That is type of what lots of people name a niche 12 months. After I completed UCLA, as an alternative of occurring to a graduate medical schooling, I simply took off for a 12 months, and this was me hair rising, , 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, really, the place I had been, and mountain climbing round, and heading to Europe, Switzerland, in reality, and I had a blister on the again of my foot simply from, , a number of strolling in sandals and never nice hygiene, I’ve to confess, on the time. Anyway, that blister obtained contaminated, and I knew sufficient to know that this was one thing severe. 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 severe medical downside. And so, I had the great fortune to have the ability to name in my individuals again house. I obtained a prescription for antibiotics, referred to as right into a pharmacy in Zurich, Switzerland, and I hobbled my method 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 this moment in lots of European pharmacies and locations all over the world, all these different medicines, proper? Along with 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 type of, like, , 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 type of humorous to consider it this fashion. I’m, like, the naturopathic physician who obtained his begin in a pharmacy the place I used to be selecting up a prescription for antibiotics, , which I’m very grateful for, but it surely opened my eyes to an entire world of medication that I didn’t know existed, and has since grow to be my ardour, my profession, my life.

Katie: What a cool story. And I’ve an identical factor, like, I undoubtedly 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 instances that it’s saved my life as properly. I believe that’s an essential caveat to recollect on this dialog. So, what sort of sufferers are you seeing now in your workplace while you’re working with individuals?

Josh: I’m glad that you simply phrased it that method, what sort of sufferers, as a result of I at all times like to consider this. Even in distinction to the mainstream or typical drugs that we’re speaking about, sure, we are able to be thankful for issues which have saved our lives, saved our limbs, however there’s additionally rather a lot to be realized from the pitfalls in Western drugs. And so, I believe the kind of affected person that I see, that’s type of like a elementary query right here. So, for me, initially, and most significantly, my sufferers are individuals first, proper? I’ve by no means seen arthritis come strolling in my workplace, though I’ve seen a number of circumstances of it. I’ve by no means seen most cancers or thyroid illness. It’s at all times been, thus far right this moment, 20-plus years and counting, an individual with arthritis, an individual with coronary heart illness, an individual with most cancers, which I believe is a extremely essential distinction, and sadly usually will get misplaced in Western drugs.

We’re gonna discuss orthopedics and musculoskeletal ache, and it’s so widespread. I imply, anyone who’s been in an enormous 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 individuals 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 number of my apply was dedicated to the care of individuals with musculoskeletal ache, however definitely not completely. After which one other form of philosophical level there’s that if a health care provider like myself treats individuals, then I deal with the issues that these individuals have, which is, once more, very completely different than Western medical specialties. I dwell 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 severe thumb downside who went to see, not only a hand physician, however somebody who focuses on thumbs, which is type of superb you probably have a thumb downside, but it surely’s fairly straightforward to really feel like that’s, the blinders are on, and all you’re being handled for is that downside. So, my apply, regardless that I had a reasonably important deal with orthopedics and musculoskeletal ache, was a apply that was just like the anti-specialty, or is a apply, it’s just like the anti-specialty. No matter you bought, you’re a human. I understand how to deal with people, let’s go. And if we have to type of transfer on down the road to higher specialization, then that’s tremendous. However principally individuals with musculoskeletal ache, and every thing 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 prognosis 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 on the subject of ache as properly, as a result of I really feel like as useful and naturopathic drugs have gotten extra well-known, individuals are wanting into extra root trigger approaches now. So, as an example, by the tip of my journey, I wasn’t only a thyroid affected person anymore. The general public I used to be working with understood the intestine connection, understood how the physique works as an entire. But it surely looks as if with ache, particularly with joints, there’s nonetheless possibly, such as you stated, some blinders there, that whereas we are able to take a look at the whole-body strategy in different areas, it’s usually a temptation to go, “Oh, you have got a knee downside,” and never take a look at the entire remainder of the physique, or not take a look at ache as being the entire remainder of the physique. And I might guess that there’s nonetheless, after all, going to be whole-body connections there. So, how do you strategy somebody who is available in with a fancy case that possibly additionally has this musculoskeletal ache, or some type of orthopedic problem?

Josh: Yeah. And that’s an ideal query. I imply, you’ll be able to completely relate. Sufferers with thyroid problems are form of generally form of simply siloed into endocrinology. And, yeah, ache is a extremely tough one, rather a lot to say right here. I imply, definitely, if somebody twists their knee and tears their ACL snowboarding, they do, they’ve a knee downside, proper? That’s fairly clear. However in addition they have ache, this mysterious sensation that we now have. I’d prefer 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 downside that we’ve all heard of most likely earlier than, it’s intriguing, referred to as phantom limb ache. That is in an individual who’s an amputee, who doesn’t have a limb. Possibly 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 forms of sensations. Actually tough to handle.

But it surely provides you this very attention-grabbing perspective while 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 is just not within the foot, proper? It will possibly’t be, as a result of there is no such thing as a foot, proper? So, right here we now have our skier that we simply talked about, who tore their ACL. Effectively, they’ve a knee. It’s simply type 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? Effectively, it definitely was generated by buildings within the knee, however the ache is perceived within the mind, proper? It’s actually a mind downside, and, yeah, it has its origins in a trauma within the knee. After which 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 are able to 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 fancy affected person with a ache dysfunction? Once more, it goes again to that elementary philosophical standpoint. It’s an individual, proper? We now have to know what tales they’ve round that ache, what it means to them, what they’re afraid of. Quite a lot of instances, there’s worry wrapped up in there. After which we now have to know diet, biomechanics, biochemistry, environmental drugs, together with toxicity and all the types of issues that useful and naturopathic docs discuss, occult infections, and all the opposite issues that might make one thing that’s traumatized or injured and in any other case painful much more painful. And I believe that’s really 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 believe there’s a lot room for serving to and therapeutic individuals in that house, in that delta.

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

Josh: Yeah, completely. And also you’re proper. I imply, ache is taken into account now an important signal, and, , that was type of an concept that wound up type of being an enormous downside, 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? Ache is a sensation that we expertise, that our physique is telling us to vary our conduct. Essentially the most type of primitive instance I can consider of that’s, like, in case your hand begins feeling actually, actually sizzling as a result of it’s near a hearth, the ache tells you that there’s one thing that should change, and that one thing is that it is advisable to transfer your hand away from the fireplace, proper? That’s nice. And that works very well. If in case you have a thorn in your foot, you’ll limp to not press extra on that thorn, these kinds of issues. It’s a really primitive type of response. And but, like, there’s all these tales that get wrapped up in it, and likewise, it will get enhanced or elevated by all of those underlying baseline elements like diet and whatnot.

So, the brief story of how…the genesis of any type of ache syndrome, I like to think about, 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 tip desk there, toe will get crushed, proper? Some tissue will get broken within the space. Hopefully, you didn’t break a bone, however, , there’s harm to the world. And it hurts. After which an entire 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 type of obtained sense…has sensors for these type of chemical substances which might be telling you that you simply’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 one thing occurring in that toe. Get on down there and begin to clear up the mess.”

So, that’s what occurs. The white blood cells infiltrate the world, and the cleanup crew begins. The purpose right here is that this inflammatory response, and we’ll get into irritation possibly even in additional element as we go alongside, is a essential a part of a therapeutic response. You’ve 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 serious, main a part of the ache generator type of cascade, is a serious goal, the place we see extreme response primarily based on the extent of the damage, proper? So, many individuals who don’t eat properly, who’re uncovered to environmental toxins, and many others., will smash that very same toe in opposition to the tip 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 a better diploma of irritation within the physique would have a heightened response to that acute irritation.

Josh: Completely. It doesn’t matter if it’s a mosquito chew or if it’s an ACL tear in a snowboarding damage. An individual who’s more healthy will reply in a more healthy method, with lowered ranges of irritation, a speedier therapeutic time, and many others. And that applies irrespective 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 also you additionally stated, like, that inflammatory response I might guess really serves a vital goal 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…generally, irritation isn’t categorically a foul factor, however you’re speaking about when we now have this systemically persistent irritation that then makes all of those responses worse?

Josh: Completely. It’s both systemically persistent 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 could be lights out. It’s completely essential. And I believe, , that is actually attention-grabbing. Maybe this, or possibly not, that irritation, it has a Latin root phrase, like so many medical phrases. Inflammo means to set ablaze. It means fireplace. Irritation is known as after fireplace. And really very like fireplace, I imply, it’s a really aptly named course of. Hearth is… Effectively, right here we’re, , at a time when the world is burning up, particularly in California, , these wildfires are so damaging. Hearth is an enormous human development and elementary to our survival, proper? We use it to cook dinner. We use it to remain heat. Harnessing fireplace was one of many biggest achievements of humankind.

However fireplace can be extraordinarily damaging, maybe probably the most 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 fireplace, we now have an enormous downside, proper? So, irritation is known as after fireplace, and correctly so. It’s essential. It’s elementary. It’s really important to our survival, however an excessive amount of is a foul deal. And an excessive amount of will be, like, a low-lying persistent burn taking place on a regular basis, such as you talked about, a persistent 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 chew, it flames up like that. And so, yeah, irritation is sweet, however an excessive amount of is just not good.

Katie: After which it looks as if a number of the primary line of strategy to, like an damage particularly, or to ache, is a few sort of anti-inflammatory ache treatment. However I might guess since this isn’t addressing the foundation explanation for the opposite irritation, and there are unwanted side effects to a number of these medication, that may, in the long run, have a destructive impact, I might guess?

Josh: Completely. I imply, yeah, the concept of suppressing irritation, , type of a superb achievement when it comes to drugs, but additionally not with out danger, proper? It is a elementary organic course of. I imply, you and I can each relate to this. If in case you have any organic course of that’s form of been…that’s a part of type 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’ll be able to’t simply get away with that perpetually. And, sure, after all, irrespective of which method you resolve to suppress irritation, whether or not or not it’s from prednisone or steroids like that, or from the extra widespread courses of over-the-counter medicines, non-steroidal anti-inflammatory medication, NSAIDs we name them, yeah, there’s gonna be a value to pay for that. So NSAIDs are, , loaded with an entire host of unwanted side effects, and steroids are much more highly effective anti-inflammatories which have much more highly effective unwanted side effects.

So, the way in which that naturopathic docs like to consider that is to assist the inflammatory course of, proper, slightly than suppress it. And, I believe, that’s a extremely large distinction between the way in which I apply drugs and type of useful integrative docs’ practices, assist versus suppress. After all, there’s a time for suppression. When an individual’s life is in danger or limbs are in danger, , suppression will be essential. But when we take into consideration this as a hierarchical type of strategy, if there are methods to assist a degenerative type of joint ache sort of syndrome, slightly than simply suppress, suppress, suppress irritation, the sufferers will virtually at all times 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 discuss a ache matrix, and type of another strategy to dealing with this, which I’m beginning to type of have the ability to pull some items primarily based on what you’ve stated, however can we go into element on this, particularly for anybody who has, like, a persistent ache like this that they’re making an attempt to work by?

Josh: Yeah, completely. And I believe that is form of elementary to the strategy. It’s one thing that developed for me over time, type of like a circulate chart or a course of, or perhaps a sample recognition, for me, within the workplace watching individuals who endure, a lot of them…and simply as a broad class, we’ll name it arthritis, proper? They’ve joints that damage. It may be their neck or their shoulders or their again or their elbows, wrists, , hips, knees, wherever the case could also be. They get lumped into this class referred to as arthritis, and once we look rigorously at these individuals, there’s a form of a sample that emerges over years of caring for them on this form of naturopathic type of method. First is, there’s one thing flawed, proper? There’s one thing flawed 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 purported to be or is bulging out in a single place or one other.

So there’s some structural integrity. Usually of people that have these sorts of issues, there’s one thing that’s structurally compromised. Fairly often, 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 docs will inform the affected person is flawed, proper? “Oh, we see this structural compromise. We see this bone spur. We see this disc factor. We see this joint house narrowing. There’s your downside,” proper? So, I’m right here to inform you that that isn’t at all times true. Actually, fairly often, it isn’t true. Structural downside is simply part of the story, as a result of, from that structural downside is that this complete matrix, this cascade of occasions that happens. The primary, and one we began to only scratch the floor on just a little bit, is when there’s structural issues, what does the physique do? Inflammatory response. Identical to we described earlier than, this inflow of white blood cells, and there’s an inflammatory response. A wholesome inflammatory response, it’ll be graded in keeping with the extent of structural trauma or structural integrity issues. But when an individual has these underlying elements, the inflammatory response may be extreme. In order that’s the primary a part of the ache matrix after the structural downside.

Structural downside results in an inflammatory response, which might be wholesome and well-controlled, or it might be uncontrolled like a wildfire. After which from there, that irritation is a set off for ache. It’s, , type of an excellent system. You’ve a traumatized or structurally compromised space, you have got some irritation, you get a sign that it hurts. So that you begin limping, otherwise you begin doing different type of conduct change…postural modifications, fairly often involving muscle rigidity. So, within the muscle tissues adjoining to the disc, or within the muscle tissues 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 widespread for individuals to have extreme quantities of muscular rigidity within the space the place there’s a structural downside and a few irritation. We name this splinting or guarding. We’ve all skilled it earlier than. When one thing hurts, you type of maintain on to it. Like, you don’t wanna transfer it extra, and it’s a really sensible physique response, proper? And when one thing’s torn or broken, you maintain on to it tighter.

Effectively, similar to irritation, there are circumstances that may lead individuals 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 tissues throughout that disc, and now issues are actually beginning to damage, proper? After which, this persists, and right here we go, the final section of the matrix, is when this persists lengthy sufficient, the muscle rigidity cuts off blood provide, and as that blood provide is reduce off, the tissue turns into, oh, gosh, extra gristly, like, much less tender. You already know, in case you consider a chunk of meat, in case you eat meat, , there’s tender, and we type of often like that. After which there’s, like, powerful, and we don’t like that an excessive amount of, not less than most individuals don’t.

And in case your muscle tissues are contracted and below rigidity, since you’re guarding them and holding for such a very long time, they will grow to be powerful, 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, while you deal with all of these different accent issues, particularly the irritation, muscle rigidity, and fibrosis, the structural downside, it doesn’t matter a lot anymore. It’s not as huge of a deal.

Katie: That is sensible. And you may appropriate me if I’m flawed on this, however I’ve heard that the structural factor doesn’t at all times essentially line up with the ache response in somebody who’s in any other case wholesome as properly. Like, as an example, I’ve heard of circumstances, individuals having a bulging disc or ruptured disc and never experiencing any ache. Whereas conversely, they’ve a minor problem and be experiencing an amazing quantity of ache.

Josh: You’re 100% proper. It’s simply superb to me, Katie, that extra docs don’t perceive this, or don’t even ask themselves that quite simple query that you simply simply raised. Take a living proof. Right here’s an individual. I simply had a case like this final week. He has again ache. You already know, it didn’t go away. He went to a health care provider. He obtained an MRI. And the MRI confirmed that he had a bulging disc, disc herniation in between L5 and S1 in his case. After which, he did some stuff. He did some PT. You already know, possibly he took some treatment, no matter it was. It’s irrelevant. He did some stuff for just a few weeks, and he obtained 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, , he simply doesn’t have the ache anymore. And that is extraordinarily widespread. So, this has been properly studied. Your level is well-taken, and also you’re completely spot-on on this one.

The presence of imaging abnormalities, like arthritic modifications, joint house narrowing, disc bulges, degenerative modifications of any type, don’t correlate with a degree of ache. There’s numerous individuals on the market who’ve all types of badness and yucky-looking stuff on MRIs, they usually really feel tremendous. 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 explanation why is the ache matrix that I simply described. It’s not at all times…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 purported to be a disc herniation. However, 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 type 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 type of a whole-person strategy, versus simply that acute trauma of the ache?

Josh: Yeah. So, and I believe speaking concerning the persistent stuff is extra related. And I’ll begin really 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 already know, we have been simply speaking about how poorly imaging findings, X-rays and MRIs, correlate with ache, proper? However there are heaps and plenty of people that get advised by their radiologist or their orthopedist, and even proven these photos, proper? They are saying, “Hey, look right here. You’ll be able to see. See the way it’s bulging out proper there. That’s an issue. See how that is asymmetrical, and there’s a narrowing over right here.” And sufferers fairly often have this picture. They’re not radiologists, they don’t know what they’re , however they’ve a picture seared into their mind by a health care provider, , an authority determine, telling them that they’re damaged. That’s what that story actually is telling them.

Actually, the affected person I simply advised 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 damaged, that my again is degenerated, that I’m a large number,” proper? “I’m falling aside.” And that could be a very unlucky casualty of that dialog. So, one of many first issues that I begin with is by telling individuals, “Look, you’re not damaged. There’s heaps of people that have disc herniations like that, they usually really feel completely tremendous. Actually, you’re gonna really feel completely tremendous in only a couple weeks, and also you’re nonetheless gonna have that disc herniation. So, you’re not damaged. You’re simply hurting. So let’s begin there,” proper? And that comes, , as an ideal aid to lots of people who actually really feel now that they’re damaged, in order that they should be cautious, they will’t run anymore, they will’t bike anymore, they will’t elevate up their youngsters or one thing like that, for worry that their damaged again is gonna actually grow to be, , a much bigger downside. I believe Western drugs, mainstream drugs does an enormous disservice to sufferers type of by chance, by telling them or implying that they’re broken, and it’s unlucky that that occurs. So, we begin there, attempt to, , reverse that story, to vary the channel, so to talk.

After which, there’s this complete world of choices that grow to be accessible to individuals, 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 about, Katie. These are issues that, like, are collagen, , a number of these connective tissues like cartilage have collagen at their base, and are fashioned of compounds that you simply’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 at all times, 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. In order that’s primary.

Quantity 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 which means dietary modifications. We will get deeper on that if we…, there’s a lot. It’s principally every thing, actually, diet and way of life, that’s the distinction between a wholesome inflammatory response and an extreme one. So we go down that street with diet and dietary modifications, and natural medicines as acceptable. After which if there’s muscle rigidity concerned, I prefer to work on that as properly. 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 finished, a lot of them with my very own arms. After which relying on the chronicity, like how lengthy the issue has been occurring, and whether or not or not there’s proof of this scarification, , particularly in outdated accidents, we attempt to do what we are able to to interrupt up that fibrosis that’s type of the scar tissue, that toughness in a muscle or delicate 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 could have a tie-over into ache, and the plus facet right here being addressing all of these elements, even in case 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, after all, we all know the entire physique is related.

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There’s lots of people on the market, particularly on the subject of ache, I’m seeing lots of people utilizing various kinds of biohacking and entering into a few of these, like, extra obscure, or simply type of fringe concepts that I believe… My take is at all times there’s a time and a spot for lots of these issues, however I at all times like to inform individuals, too, I believe 80% of it’s the belongings you’re doing each day, small habits, issues which might be free, your sleep, your stress, your meals, your motion. However I do additionally assume there could be a time and a spot for these. However I’m curious your tackle that, as a result of a number of these do appear to line up with musculoskeletal or bodily efficiency. So, do you utilize any of these therapies, and if that’s the case, how?

Josh: Yeah. I recognize this query, and it’s an ideal one. And it’s virtually controversial just a little bit. I do know that world very properly, like, the well being and wellness world, , and the attraction to the brand new…you utilize the phrase fringe. You already know, the “progressive” may be…, we love shiny new objects on this nation, and that’s definitely no completely different on the earth of orthopedics and musculoskeletal ache. We additionally should do not forget that ache is a large motivator. Like, individuals 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 believe it’s true that…you utilize the phrase “biohacker,” which is sort of an entire group, an entire 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 fully agree with you. I imply, I consider…and I’m gonna use just a little allegory right here for a minute. If there’s a fly buzzing round in our kitchen, there’s a number of completely different choices that we now have for that. And me, and I think you may be related, I prefer to attempt to, like, open up the window and see if I can get him out. You already 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 just a little more durable. After which, 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 could possibly spray that across the kitchen and kill it. After which, 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 downside. 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 degree of drive, there’s rising ranges of toxicity or trauma to the kitchen, proper? Like, you pull out the flamethrower, there’s gonna be an enormous 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 recent fancy stuff. And people will be nice, however they’re type of up in that increased 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 light stuff, the dietary modifications, the approach to life modifications, posture, biomechanics, therapeutic massage, dietary remedy, natural remedy. That’s the opening the door or the window. After which 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. After which that developed, and lots of people now are doing PRP, platelet-rich plasma injections, the place we extract the platelets, which have progress elements in there, type of a one-up to the outdated prolotherapy. After which 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 also you requested am I into that. Yeah. I’m into all of that. I believe 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. However in case you’re asking am I into that, like, proper out the gates? Completely not. I share your ideas. I wanna work with the open the door for the fly strategy first, dietary, natural, dietary, and type of work my method up that ladder, up that hierarchy. And so long as remedies are protected, and protected is each protected to the affected person, after all, and likewise protected to their pocketbook… I believe there’s some huge cash to be made in a number of these fancy interventions, too. So, “protected,” I’d use the time period very broadly. But when it’s affordable intervention, and it’s protected for the individual, and may be efficient earlier than pulling out the flamethrower, then yeah, let’s go, . In order that’s the place I’m at with biohacking and novel progressive therapies.

Katie: Yeah. It looks as if an essential type of development of the depth of therapies there. That was an ideal analogy. And I’ve at all times heard it stated that individuals 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 instructor, to your level. And so, I might 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 keen to vary, and also you’re capable of then educate about the entire methods during which they will try this, that even when they find yourself needing sooner or later a kind 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 sooner or later, than if they’d not addressed these issues. As a result of as you have been speaking about this, I’m imagining, , 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 harm within the physique, so their restoration from that may be 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 downside that I’ve is now not acceptable to me.” They usually’re keen to do one thing about it, proper? And I believe the objective of the doctor, I imply, definitely, it’s not a method I’ve ever actually considered my job, however it’s, to form of assess, like, “All proper. Like, how problematic is that this? What are you keen to do? What modifications are you keen to make?” It’s definitely a dialogue that we at all times have, like, how a lot do you want your present food plan? How a lot do you want your present inactive way of life? Or, in some circumstances, how a lot do you want that operating that you simply do, that’s simply messing up your knee? And I’ve had numerous folks that I’ve needed to say, , “I believe it may be time to change to a bicycle.” And it’s brutal. It’s a brutal actuality test for them to should assess, like, “Yeah. I’m on a precipice proper right here. I can’t cope with this hip state of affairs anymore. I’ve to make a change.”

And, yeah, for some individuals, which means I’m able to have a surgeon reduce me open and take my outdated hip out and put a brand new one in. However there’s many…I might say not…I don’t know if I wanna say most. In my apply, I’d say, , 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 far more gratifying may a profession be, to have the ability to assist individuals keep away from these type of costly, scary interventions, and as an alternative use pure therapies? And, yeah, it’s unlucky that we now have to… It’s. It’s very arduous to get individuals to vary till there’s some motive that just about forces them. And, yeah, really, in a number of methods, makes my job simpler, proper? Right here they’re. They’re able to go, . So I simply assist usher them alongside that path.

Katie: And I’m certain it’s refreshing for them to work with somebody who is just not making an attempt to push them into the high-ticket, costly, and considerably drastic choices, but additionally tackle these root causes first. And I additionally assume, if we are able to shift…since you talked about the mindset a few instances. I believe if we shift our mindset, we are able to have excessive gratitude when there’s ache, as a result of it’s an unbelievable instructor, and it will get our consideration, and we are able to study a lesson, and hopefully, we do, in a method 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 mix of unusual and strange elements, getting rhabdo. Which isn’t a factor that may usually have occurred to me, however I had had blood loss after which a collection of issues that type of compounded, and I obtained rhabdo. And the ache of that was sufficient to get my consideration. And undoubtedly, I used to be capable of tackle some issues by that have and study classes about not pushing myself too arduous in sure areas, which have been essential to study.

However I believe if we reframe it, like, any type of ache, even emotional ache, there’s a number of metaphors there, turns into an ideal instructor 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 might guess, additionally improve our resilience if we’re injured or if we encounter ache, as a result of if we tackle all these items beforehand, it could appear to be we are able to deal with these issues higher in the event that they happen. Is that your expertise as properly?

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 tremendous. So I hope that’s true. Yeah. The expertise of ache is a good instructor certainly, and I believe that we dwell in a world, society, definitely within the healthcare universe, the place we wanna simply suppress it. We would like nothing to do with it, proper? We wanna keep forward of it so to talk, medicate it away, and we’re dropping rather a lot once we try this. Now, after all, the ache is uncomfortable, proper? It’s uncomfortable for a motive, and when an individual is ready to form of take a pair deep breaths and type of go lean into that ache, that is what a number of the mindfulness work spearheaded by Jon Kabat-Zinn and so many others, , about utilizing cognitive conduct remedy and mindfulness as pertains to ache, will be superb, highly effective instruments that don’t contain any change, , in diet, however have radical impression on the biochemistry and the entire form of neurochemistry of ache.

And completely, I believe, we have to take it for what it’s price. You already 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. However, sure, it’s certainly a lesson, a instructor, and there’s at all times, and I might say at all times, 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, , your life historical past tells a sure story, and you then come up in opposition to some type of ache, you’ll take that ache expertise, and it’ll grow to be a part of your story. And which may make it damage roughly, relying on what your background is and what tales you’re telling your self about it. And so, I believe that as a part of a complete form of naturopathic administration to a ache syndrome, whether or not it’s a persistent downside or an acute downside, is that the evaluation of that story, and making an attempt to assist individuals discover methods to reframe it in a method that makes it a constructive expertise for them finally.

Katie: I really like that. And as we get near the tip of our time, just a few questions I like to ask, the primary being if there’s a e book or a lot of books which have had a profound impression in your life, and if that’s the 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 referred to as “Ferdinand the Bull.” And that could be a child’s e book that I’ve just a few 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 obtained stung by a bee. Discuss 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 most important, fiercest bull. He will get stung by a bee. He jumps up, he runs round loopy, they usually say, “Oh, we discovered our bull.” They usually convey 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 at all times did out within the pasture, and odor the flowers. He’s a peaceable, sort bull. He doesn’t wanna battle. And that’s at all times been my favourite e book, and it stays my favourite e book to this present day. It’s nearly, I don’t know, peace, smelling flowers, and non-violence. I simply love “Ferdinand the Bull.” So I recognize the query and the reminiscences it evokes.

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

Josh: Thanks. Yeah. So, my apply, and proper now my apply is…I’m a busy individual, so my apply is full to new sufferers for the time being. That may at all times change, relying on all kinds of various skilled and private life issues. My apply is right here in Hamden, Connecticut, and we now have 5 different docs there as properly. That’s a apply referred to as Complete Well being in Hamden, Connecticut. And the web site for our apply 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 referred to 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 advised you at the start I’m a surfer, and upwelling… That is an attention-grabbing little facet observe for you. UpWellness is the identify of our firm, and our tagline known as “Nutrient-Wealthy Residing.”

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 beneath, 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 beneath of chilly water, and we expertise that as a chilly patch. But it surely’s additionally a nutrient-rich infusion, so therefore the identify of our firm, UpWellness, “Nutrient-Wealthy Residing,” and upwellness.com is the place individuals will discover all of the merchandise that we create that assist individuals 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 properly. I had a few of your merchandise in my espresso this morning. It was scrumptious.

Josh: Nice.

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

Josh: Oh, gosh, , we’re…I believe, type of my tagline that I educate to my youngsters that I attempt to, , most likely educate to myself as a lot as anyone, is simply to be sort to one another. We’re in a extremely difficult time, , and I don’t wanna get into it, all of the division that’s on the market. However I believe that there’s just a few elementary guidelines, and kindness might be on the prime of that checklist that might assist a number of us, , get alongside higher and remedy among the nice world issues if we simply saved 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 might encourage individuals to search for methods to seek out awe, A-W-E, , 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.

However superior is one thing that, , makes us really feel small, makes us really feel humble, makes us understand that the world is that this larger 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. In case 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 when it comes to anti-inflammatory results. So, be sort, and be superior.

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

Josh: Yeah. They’ve. They studied that at Berkeley. Yeah. They usually’re all helpful, for certain, like gratitude, love, pleasure, all clearly helpful, however while you take 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 place to begin with browsing, and I undoubtedly realized rather a lot right this moment. I’m grateful for the work that you simply do. I do know we didn’t even get to actually delve into your merchandise that a lot, however I’ll put a hyperlink within the present notes. I’m an enormous fan, so I’ll put a hyperlink, individuals can discover these. All the pieces we talked about might be at wellnessmama.fm. And Dr. Josh, thanks a lot to your time right this moment.

Josh: It was an actual pleasure, Katie. Thanks.

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

In case you’re having fun with these interviews, would you please take two minutes to depart a ranking or evaluate on iTunes for me? Doing this helps extra individuals to seek out the podcast, which implies much more mothers and households may gain advantage from the data. I actually recognize your time, and thanks as at all times for listening.

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