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Katie: Hi there, 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 typical and pure drugs, he’s a naturopathic physician that has a very complicated, distinctive method to coping with musculoskeletal ache and orthopedic ache. And he talks right now about his wide-ranging method to this and why it’s rather more than simply addressing the acute ache. And he talks about how he received began as a naturopathic physician, the sufferers he works with and his method to care, the foundation causes of ache, the mind-body connection that we will perceive via 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 lots of completely different areas. I believe you’ll be taught 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 presently in the course of a tropical storm, which is the one time we have now good waves in our space. So after this podcast, I will likely be taking a few of my youngsters to log on in a hurricane. However I’ve a observe that in case you had been gonna give a TED speak, you’ll discuss how browsing imitates life. So, I do know this could possibly 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 very best waves. I do know it sounds loopy to folks, when everybody else is desirous 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, in the future, I’ll most likely sort of develop a complete speak 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 follow is about steadiness, and browsing and surfers, I believe, are sort of just like the individuals who can be accused of getting actually good steadiness, proper? It’s a balance-intensive train, and so, you already know, we speak rather a lot about steadiness. And I’m certain, you already know, it’s a topic that comes up, work-life steadiness, marital steadiness, you already know, all these types of issues in steadiness and well being and wellness and holding your self collectively.
And so, you already know, a surfer looks as if individual to speak to about that, proper? Effectively, it seems that in browsing, and I suppose it’s additionally true in life, there’s not likely something…there’s no static mounted level of steadiness, proper? Browsing is that this, like, ever motion, ever-fluid exercise that requires fixed kind of evaluation of what’s occurring 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. 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 means, and you progress the opposite means. And I’d argue that in life, this concept, there’s a pursuit that lots of people are in search of, “I wanna discover steadiness in my marriage, steadiness in my parenting, steadiness in my work, steadiness in my life.” And I sort of wanna inform those 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 learn to successfully handle the imbalance, and also you’ll be a lot better off, in order that’s sort of like simply one of many bullet factors of my browsing imitates life speak. And, sure, we might go on and on.
Katie: I like that. I hope you truly try this as a chat in the future. And I agree with you. I’ve written about that too, that, like, steadiness is a transferring goal, and adaptableness is rather more essential than discovering that mounted level usually.
Josh: Completely.
Katie: And likewise I wanna be sure that we have now lots 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 a point, and from what I’m seeing, it’s one thing that’s on the rise as effectively. However, to start out broad and sort of perceive how you bought right here, I’ve a observe that you simply went to UCLA on a pre-med observe, and then you definitely pivoted. So, are you able to stroll us via what induced that change for you?
Josh: Yeah, completely. And, sure, we’ll spend nearly all 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 type or one other. Yeah. I used to be a type of youngsters who simply at all times wished to be a physician. So, it simply made sense. I studied neurophysiology at UCLA, and I had the great fortune to kind of, like, develop into pleasant with, due to parental relationships, with lots of docs 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 had been seeing the adjustments afoot. A lot of them have truly come to move now, referring to insurance coverage firms and large pharma and all that kind of stuff. Life as a physician, as they used to comprehend it, wasn’t nearly as good, and they also had been saying, you already know, “I don’t know in case you wanna do that. You understand, it’s gonna simply worsen.”
So I took that recommendation and took off, for a yr. That is sort of what lots of people name a spot 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 already know, hitchhiking and touring around the globe with a backpack, sleeping in youth hostels, sleeping on seashores, all that kind 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 already know, lots of strolling in sandals and never nice hygiene, I’ve to confess, on the time. Anyway, that blister received 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 drawback. And so, I had the great fortune to have the ability to name in my folks again dwelling. I received a prescription for antibiotics, referred to as right into a pharmacy in Zurich, Switzerland, and I hobbled my means 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 around the globe, 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…perhaps it’s as a result of I used to be sort of, like, you already know, 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 received his begin in a pharmacy the place I used to be choosing up a prescription for antibiotics, you already know, which I’m very grateful for, however it opened my eyes to a complete world of drugs that I didn’t know existed, and has since develop into my ardour, my profession, my life.
Katie: What a cool story. And I’ve an analogous factor, like, I undoubtedly have a tendency towards the pure facet of issues most frequently, however I additionally very firmly imagine 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 believe that’s an essential caveat to recollect on this dialog. So, what sort of sufferers are you seeing now in your workplace if you’re working with folks?
Josh: I’m glad that you simply phrased it that means, 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 will 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 sort of like a elementary query right here. So, for me, initially, 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 lots of instances of it. I’ve by no means seen most cancers or thyroid illness. It’s at all times 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 believe is a very 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 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 instances, in my world, individuals who have ache. So, lots of my follow was dedicated to the care of individuals with musculoskeletal ache, however actually not solely. After which one other kind of philosophical level there may be that if a physician 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 severe thumb drawback who went to see, not only a hand physician, however somebody who focuses on thumbs, which is sort of wonderful in case you have a thumb drawback, however 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. No matter 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 larger specialization, then that’s wonderful. However largely folks with musculoskeletal ache, and the whole lot else, too, is my reply to that one.
Katie: I 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 the case of ache as effectively, as a result of I really feel like as practical and naturopathic drugs have gotten extra well-known, persons are wanting into extra root trigger approaches now. So, for example, by the top of my journey, I wasn’t only a thyroid affected person anymore. Most people I used to be working with understood the intestine connection, understood how the physique works as a complete. Nevertheless it looks as if with ache, particularly with joints, there’s nonetheless perhaps, such as you mentioned, some blinders there, that whereas we will have a look at the whole-body method in different areas, it’s usually a temptation to go, “Oh, you may have a knee drawback,” 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, after all, going to be whole-body connections there. So, how do you method somebody who is available in with a posh case that perhaps additionally has this musculoskeletal ache, or some sort of orthopedic difficulty?
Josh: Yeah. And that’s a fantastic query. I imply, you’ll be able to completely relate. Sufferers with thyroid problems are kind of generally kind of simply siloed into endocrinology. And, yeah, ache is a very tough one, rather a lot to say right here. I imply, actually, if somebody twists their knee and tears their ACL snowboarding, they do, they’ve a knee drawback, proper? That’s fairly clear. However in addition they have ache, this mysterious sensation that we have now. I’d prefer to kind 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, 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 harm or regardless of the case could also be, they usually nonetheless have ache in that limb, or itching or different forms of sensations. Actually troublesome to handle.
Nevertheless it provides you this very attention-grabbing perspective if 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 just isn’t within the foot, proper? It may well’t be, as a result of there is no such thing as a foot, proper? So, right here we have now our skier that we simply talked about, who tore their ACL. Effectively, 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? Effectively, it actually was generated by buildings 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. After which the mind grabs a maintain of those indicators which are 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 pressure and fibrosis, and we will speak 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 method a posh affected person with a ache dysfunction? Once more, it goes again to that elementary philosophical standpoint. It’s an individual, proper? We’ve to grasp what tales they’ve round that ache, what it means to them, what they’re afraid of. A variety of occasions, there’s worry wrapped up in there. After which we have now to grasp vitamin, biomechanics, biochemistry, environmental drugs, together with toxicity and all the types of issues that practical and naturopathic docs discuss, 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 believe 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 harm or trauma deserves, proper? And I believe there’s a lot room for serving to and therapeutic folks in that area, in that delta.
Katie: Yeah. So, let’s go deeper on that, as a result of having had a number of 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. Nevertheless it appears like from what you’re saying, there’s lots of issues that could possibly be accomplished otherwise and on completely different ranges that will actually change outcomes. So, let’s go deeper on that, and the way that could possibly be accomplished otherwise.
Josh: Yeah, completely. And also you’re proper. I imply, ache is taken into account now an important signal, and, you already know, 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 have now now, treating ache, managing ache, staying forward of ache, all that kind of stuff. When the truth 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 sort 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 you could transfer your hand away from the hearth, proper? That’s nice. And that works rather well. You probably 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 brief story of how…the genesis of any sort of ache syndrome, I like to think about, like, you get up in the course of the night time to go use the toilet or one thing and smash your toe towards 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 already know, there’s injury to the realm. And it hurts. After which 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 received sense…has sensors for these sort of chemical compounds which are telling you that you simply’ve been traumatized in a roundabout way. And that kicks off this superior, extraordinarily complicated cascade of interactions involving cytokines and leukotrienes, prostaglandins, and issues which are all these chemical indicators 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 realm, and the cleanup crew begins. The purpose right here is that this inflammatory response, and we’ll get into irritation perhaps even in additional element as we go alongside, is a crucial a part of a therapeutic response. You may have a, I consider a matrix of occasions that occurs, tissue harm, after which some ache, after which irritation, after which muscular pressure 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 harm, proper? So, many individuals who don’t eat effectively, who’re uncovered to environmental toxins, and many others., will smash that very same toe towards the top desk and see a larger inflammatory response. And so, the extent of ache, the extent of irritation in response to an harm is instantly 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 harm 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: Completely. It doesn’t matter if it’s a mosquito chunk or if it’s an ACL tear in a snowboarding harm. An individual who’s more healthy will reply in a more healthy means, with decreased ranges of irritation, a speedier therapeutic time, and many others. 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 harm like a trauma.
Katie: And also you additionally mentioned, 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, identical to there’s an inflammatory response post-exercise, that results in muscle development. So that is…basically, irritation isn’t categorically a foul factor, however you’re speaking about when we have now this systemically continual irritation that then makes all of those responses worse?
Josh: Completely. It’s both systemically continual or extreme in response to trauma or an infection or harm. And the best way I like to consider it…and, sure, you’re proper. The inflammatory response is a elementary a part of kind of human immunological reactions. If we didn’t have it, it could be lights out. It’s completely crucial. And I believe, you already know, that is actually attention-grabbing. Maybe you already know this, or perhaps not, that irritation, it has a Latin root phrase, like so many medical phrases. Inflammo means to set ablaze. It means hearth. Irritation is known as after hearth. And really very like hearth, I imply, it’s a really aptly named course of. Hearth is… Effectively, right here we’re, you already know, at a time when the world is burning up, particularly in California, you already know, these wildfires are so harmful. Hearth is an enormous 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.
However hearth can also be extraordinarily harmful, maybe probably the most harmful forces on the planet, and so irritation could be very a lot the identical. Like, we love a candlelit dinner, but when the candle catches the curtains on hearth, we have now a giant drawback, proper? So, irritation is known as after hearth, and correctly so. It’s crucial. It’s elementary. It’s truly important to our survival, however an excessive amount of is a foul deal. And an excessive amount of could be, like, a low-lying continual burn occurring 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 harm, a mosquito chunk, it flames up like that. And so, yeah, irritation is sweet, however an excessive amount of just isn’t good.
Katie: After which it looks as if lots of the primary line of method to, like an harm particularly, or to ache, is a few kind of anti-inflammatory ache medicine. However I’d guess since this isn’t addressing the foundation reason for the opposite irritation, and there are negative effects to lots of these medication, that may, in the long run, have a unfavourable impact, I’d guess?
Josh: Completely. I imply, yeah, the thought of suppressing irritation, you already know, sort of a superb achievement by way of drugs, but additionally not with out threat, proper? This can be a elementary organic course of. I imply, you and I can each relate to this. You probably have any organic course of that’s kind 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 possibly can’t simply get away with that perpetually. And, sure, after all, regardless of which means you determine 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 drugs, non-steroidal anti-inflammatory medication, NSAIDs we name them, yeah, there’s gonna be a value to pay for that. So NSAIDs are, you already know, loaded with a complete host of negative effects, and steroids are much more highly effective anti-inflammatories which have much more highly effective negative effects.
So, the best way 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 very enormous distinction between the best way I follow drugs and sort of practical 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, you already know, suppression could be crucial. But when we take into consideration this as a hierarchical sort of method, if there are methods to assist a degenerative sort of joint ache kind of syndrome, slightly than simply suppress, suppress, suppress irritation, the sufferers will nearly 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 could possibly be very counterproductive in the long run. And in my notes, you discuss a ache matrix, and sort of an alternate method to dealing with this, which I’m beginning to sort of be capable of pull some items based mostly on what you’ve mentioned, 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 via?
Josh: Yeah, completely. And I believe that is kind of elementary to the method. It’s one thing that advanced for me over time, sort of like a circulate chart or a course of, or perhaps a sample recognition, for me, within the workplace watching individuals who endure, lots of them…and simply as a broad class, we’ll name it arthritis, proper? They’ve joints that harm. It could be their neck or their shoulders or their again or their elbows, wrists, you already know, hips, knees, wherever the case could also be. They get lumped into this class referred to as arthritis, and once we look fastidiously at these folks, there’s a kind of a sample that emerges over years of caring for them on this kind of naturopathic sort of means. First is, there’s one thing mistaken, proper? There’s one thing mistaken with the joint. It could be that the cartilage is thinned out. It could be that there’s bone spurring within the space. It could be {that a} disc within the cervical or lumbar backbone is thinner than it’s presupposed 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 could be very usually the one factor that the docs will inform the affected person is mistaken, proper? “Oh, we see this structural compromise. We see this bone spur. We see this disc factor. We see this joint area narrowing. There’s your drawback,” proper? So, I’m right here to let you know that that isn’t at all times true. The truth is, 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 primary, and one we began to simply scratch the floor on somewhat bit, is when there may be structural issues, what does the physique do? Inflammatory response. Similar 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 line with the extent of structural trauma or structural integrity issues. But when an individual has these underlying elements, the inflammatory response could be extreme. In order that’s the primary a part of the ache matrix after the structural drawback.
Structural drawback results in an inflammatory response, which could possibly be wholesome and well-controlled, or it could possibly be uncontrolled like a wildfire. After which from there, that irritation is a set off for ache. It’s, you already know, sort of an excellent system. You may have a traumatized or structurally compromised space, you may have some irritation, you get a sign that it hurts. So that you begin limping, otherwise you begin doing different sort of conduct change…postural adjustments, fairly often involving muscle pressure. 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 widespread for folks to have extreme quantities of muscular pressure 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 sensible physique response, proper? And when one thing’s torn or broken, you maintain on to it tighter.
Effectively, identical to irritation, there are circumstances that can lead folks to carry tighter and maintain longer than they need to with that muscular pressure, and if that muscular pressure persists, you wind up having muscular pressure as a brand new ache generator, proper? So, right here we have now a structurally compromised disc, some irritation within the space of the disc, now muscle pressure within the muscle mass throughout that disc, and now issues are actually beginning to harm, proper? After which, this persists, and right here we go, the final section of the matrix, is when this persists lengthy sufficient, the muscle pressure cuts off blood provide, and as that blood provide is lower off, the tissue turns into, oh, gosh, extra gristly, like, much less tender. You understand, in case you consider a chunk of meat, in case you eat meat, you already know, there’s tender, and we sort of normally like that. After which there’s, like, robust, and we don’t like that an excessive amount of, no less than most individuals don’t.
And in case your muscle mass are contracted and underneath pressure, since you’re guarding them and holding for such a very long time, they will develop 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 pressure to fibrosis, that package deal is what hurts. And fairly often, if you deal with all of these different accent issues, particularly the irritation, muscle pressure, 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 may right me if I’m mistaken 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 effectively. Like, for example, I’ve heard of instances, folks having a bulging disc or ruptured disc and never experiencing any ache. Whereas conversely, they’ve a minor difficulty and be experiencing an incredible quantity of ache.
Josh: You’re 100% proper. It’s simply wonderful 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 understand, it didn’t go away. He went to a physician. He received 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 understand, perhaps he took some medicine, no matter it was. It’s irrelevant. He did some stuff for a number of weeks, and he received higher. So now his again doesn’t harm anymore. So, if…we’ll do a theoretical right here…we had been to shoot the MRI once more, he nonetheless has a disc herniation. So, you already know, he simply doesn’t have the ache anymore. And that is extraordinarily widespread. 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 area narrowing, disc bulges, degenerative adjustments of any kind, don’t correlate with a stage of ache. There’s plenty of folks on the market who’ve every kind of badness and yucky-looking stuff on MRIs, they usually really feel wonderful. And there’s every kind 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 presupposed to be a disc herniation. However, if there’s extreme irritation, muscle pressure, fibrosis in and round that space, that’s the distinction between that disc herniation hurting and never hurting. And that’s essentially 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 suppose they do.
Katie: So, with that extra complete understanding of ache, what’s your method to treating that in a sort of a whole-person method, versus simply that acute trauma of the ache?
Josh: Yeah. So, and I believe speaking concerning the continual stuff is extra related. And I’ll begin truly by going again to one thing that we mentioned earlier than, which was concerning the expertise of the ache itself and the tales that we inform ourselves. You understand, we had 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 instructed by their radiologist or their orthopedist, and even proven these pictures, proper? They are saying, “Hey, look right here. You possibly can 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 taking a look at, however they’ve a picture seared into their mind by a physician, you already know, an authority determine, telling them that they’re damaged. That’s what that story actually is telling them.
The truth is, 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 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 folks, “Look, you’re not damaged. There’s heaps of people that have disc herniations like that, they usually really feel completely wonderful. The truth is, you’re gonna really feel completely wonderful 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, you already know, as a fantastic aid to lots of people who actually really feel now that they’re damaged, in order that they need to be cautious, they will’t run anymore, they will’t bike anymore, they will’t carry up their youngsters or one thing like that, for worry that their damaged again is gonna actually develop into, you already know, a much bigger drawback. I believe Western drugs, mainstream drugs does an enormous disservice to sufferers sort of by accident, by telling them or implying that they’re broken, and it’s unlucky that that occurs. So, we begin there, attempt to, you already know, reverse that story, to vary the channel, so to talk.
After which, there’s this complete world of choices that develop 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 already know about, Katie. These are issues that, like, are collagen, you already know, lots of these connective tissues like cartilage have collagen at their base, and are shaped 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 are 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 nearly 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 adjustments. We are able to get deeper on that if we…you already know, there’s a lot. It’s mainly the whole lot, 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. After which if there may be muscle pressure concerned, I prefer 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 accomplished, lots of them with my very own palms. 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, you already know, particularly in previous 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 gentle tissues round an affected joint. And that’s the package deal.
Katie: And, yeah, it looks as if a way more complete method that will have constructive ripples. I imply, the thought 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 linked.
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There’s lots of people on the market, particularly in the case of ache, I’m seeing lots of people utilizing various kinds of biohacking and moving into a few of these, like, extra obscure, or simply sort 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 folks, too, I believe 80% of it’s the belongings you’re doing every day, small habits, issues which are free, your sleep, your stress, your meals, your motion. However I do additionally suppose there could be a time and a spot for these. However I’m curious your tackle that, as a result of lots 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 a fantastic one. And it’s nearly controversial somewhat bit. I do know that world very effectively, like, the well being and wellness world, you already know, and the attraction to the brand new…you utilize the phrase fringe. You understand, the “progressive” could be…you already know, we love shiny new objects on this nation, and that’s actually no completely different on the planet of orthopedics and musculoskeletal ache. We additionally need to do not forget that ache is a big 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 every kind 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, a complete universe, actually, progressive medical stuff, could 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 lots of completely different choices that we have now for that. And me, and I believe you could be comparable, I prefer to attempt to, like, open up the window and see if I can get him out. You understand, 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 typically works. There’s some dangers to it. It could be somewhat more durable. After which, I would step it as much as, like, the rolled-up newspaper or the fly swatter, after which I would 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 can spray that across the kitchen and kill it. After which, if it’s nonetheless not going away, we might pull out, like, a flamethrower, proper?
And the thought right here is that, like, there’s rising ranges of power that could possibly be used to deal with an issue, on this case, the fly drawback. I just like the least power. That’s the best way I love to do it. And if that doesn’t work, we step it up. And with every rising stage of power, 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 have now this on a regular basis, proper? We love surgical procedure. We love injections. We love prolotherapy, PRP, Lipogems, all of latest fancy stuff. And people could be nice, however they’re sort 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 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. After which we go up from there. And, yeah, there could be a time the place we want medicine or an injection of some kind, 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 advanced, and lots of people now are doing PRP, platelet-rich plasma injections, the place we extract the platelets, which have development elements in there, sort of a one-up to the previous prolotherapy. After which up from there, we have now a bunch of fancy new peptides which are 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 wonderful, and it’s superior, particularly if it comes earlier than the subsequent 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 method first, dietary, natural, dietary, and sort of work my means 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 in addition protected to their pocketbook… I believe there’s some huge cash to be made in lots of these fancy interventions, too. So, “protected,” I’d use the time period very broadly. But when it’s cheap intervention, and it’s protected for the individual, and could be efficient earlier than pulling out the flamethrower, then yeah, let’s go, you already know. In order that’s the place I’m at with biohacking and novel progressive therapies.
Katie: Yeah. It looks as if an essential sort of development of the depth of therapies there. That was a fantastic analogy. And I’ve at all times heard it mentioned that individuals solely change when the ache of staying the identical turns into larger than the ache of fixing, 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 vary, and also you’re in a position to then educate about all the methods during which they will try this, that even when they find yourself needing in the future a type of extra superior issues like surgical procedure, hopefully not, however their physique is gonna most likely be in a a lot better state to deal with surgical procedure, or deal with no matter they want in the future, than if they’d not addressed these issues. As a result of as you had been speaking about this, I’m imagining, you already know, 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 via 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 troublesome in the event that they haven’t addressed these different elements.
Josh: Yeah, completely. It was so eloquent the best way you simply described that, Katie. It’s so true. That’s the place persons are, proper? That’s the precipice that they’re on, “This drawback that I’ve is not acceptable to me.” They usually’re prepared to do one thing about it, proper? And I believe the objective of the doctor, I imply, actually, it’s not a means I’ve ever actually considered my job, however it’s, to kind of assess, like, “All proper. Like, how problematic is that this? What are you prepared to do? What adjustments are you prepared to make?” It’s actually a dialogue that we at all times have, like, how a lot do you want your present weight loss program? How a lot do you want your present inactive way of life? Or, in some instances, how a lot do you want that working that you simply do, that’s simply messing up your knee? And I’ve had numerous those who I’ve needed to say, you already know, “I believe it could be time to change to a bicycle.” And it’s brutal. It’s a brutal actuality test for them to need to assess, like, “Yeah. I’m on a precipice proper right here. I can’t cope with this hip scenario anymore. I’ve to make a change.”
And, yeah, for some folks, which means I’m able to have a surgeon lower me open and take my previous hip out and put a brand new one in. However there’s many…I’d say not…I don’t know if I wanna say most. In my follow, I’d say, you already know, 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 might 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 have now to… It’s. It’s very laborious to get folks to vary till there’s some purpose that nearly forces them. And, yeah, truly, in lots of methods, makes my job simpler, proper? Right here they’re. They’re able to go, you already know. So I simply assist usher them alongside that path.
Katie: And I’m certain it’s refreshing for them to work with somebody who just isn’t making an attempt to push them into the high-ticket, costly, and considerably drastic choices, but additionally deal with these root causes first. And I additionally suppose, if we will shift…since you talked about the mindset a few occasions. I believe if we shift our mindset, we will have excessive gratitude when there’s ache, as a result of it’s an unimaginable trainer, and it will get our consideration, and we will be taught a lesson, and hopefully, we do, in a means that has constructive results. Going ahead, I do know for me, I’ll, like, get susceptible for a second. Just a few months in the past, I ended up, via a mix of unusual and weird elements, getting rhabdo. Which isn’t a factor that will usually have occurred to me, however I had had blood loss after which a collection of issues that sort of compounded, and I received rhabdo. And the ache of that was sufficient to get my consideration. And undoubtedly, I used to be in a position to deal with some issues via that have and be taught classes about not pushing myself too laborious in sure areas, which had been essential to be taught.
However I believe if we reframe it, like, any sort of ache, even emotional ache, there’s lots of metaphors there, turns into a fantastic trainer if we let it. And if we don’t resist it, if we let it train us, after which combine these habits and transfer ahead, and even for somebody who perhaps 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 these items beforehand, it could seem 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 aside from me to say I hope it was a speedy and full restoration for you. It looks as if you’re doing simply wonderful. So I hope that’s true. Yeah. The expertise of ache is a superb trainer certainly, and I believe that we stay in a world, society, actually within the healthcare universe, the place we wanna simply suppress it. We wish 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 purpose, and when an individual is ready to kind of take a pair deep breaths and sort of go lean into that ache, that is what lots of the mindfulness work spearheaded by Jon Kabat-Zinn and so many others, you already know, about utilizing cognitive conduct remedy and mindfulness as pertains to ache, could be wonderful, highly effective instruments that don’t contain any change, you already know, in vitamin, however have radical affect on the biochemistry and the entire kind of neurochemistry of ache.
And completely, I believe, we have to take it for what it’s value. You understand, completely, if it’s disabling or incapacitating, there’s instruments that we have now and we should always be thankful for to assist handle that. However, sure, it’s certainly a lesson, a trainer, and there’s at all times, and I’d say at all times, I imply, we don’t get to say that too usually in drugs, tales that we have now which are borne of our personal experiences, that inform what our expertise is of that ache. And so, if, you already know, your life historical past tells a sure story, and then you definitely come up towards some sort of ache, you’ll take that ache expertise, and it’ll develop into a part of your story. And that may make it harm 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 kind 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 means that makes it a constructive expertise for them finally.
Katie: I like that. And as we get near the top of our time, a number of questions I like to ask, the primary being if there’s a guide or quite a lot of books which have had a profound affect in your life, and if that’s the case, what they’re and why?
Josh: Yeah. I do know your fashion with this query, and I like this query. And my reply is a guide referred to as “Ferdinand the Bull.” And that could be a child’s guide that I’ve a number of copies of. It was my favourite guide as a baby, and it stays my favourite guide as an grownup. It’s the story of Ferdinand the bull, who received 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 largest, 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 deliver Ferdinand the bull to go struggle 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 scent the flowers. He’s a peaceable, sort bull. He doesn’t wanna struggle. And that’s at all times been my favourite guide, and it stays my favourite guide to at the present time. 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 recollections it evokes.
Katie: I 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 method and/or work with you if you’re taking new sufferers?
Josh: Thanks. 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 may at all times change, relying on all types of various skilled and private life issues. My follow is right here in Hamden, Connecticut, and we have now 5 different docs there as effectively. That’s a follow referred to as Complete Well being 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 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 instructed you firstly I’m a surfer, and upwelling… That is an attention-grabbing little facet observe for you. UpWellness is the title 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. Nevertheless it’s additionally a nutrient-rich infusion, so therefore the title of our firm, UpWellness, “Nutrient-Wealthy Residing,” 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 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: Nice.
Katie: I’ll be sure that folks can discover these. And any parting recommendation to go away with the viewers right now?
Josh: Oh, gosh, you already know, we’re…I believe, sort of my tagline that I train to my youngsters that I attempt to, you already know, most likely train to myself as a lot as anyone, is simply to be sort to one another. We’re in a very difficult time, you already know, 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 high of that checklist that would assist lots of us, you already know, get alongside higher and clear up a number of 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’d encourage folks to search for methods to search out awe, A-W-E, you already know, once more, a surfer phrase. We use the phrase superior, proper, after which surfers perhaps co-opted that phrase to explain waves, or maneuvers on waves.
However superior is one thing that, you already know, makes us really feel small, makes us really feel humble, makes us notice 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. Should 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 essentially the most highly effective constructive emotion by way of anti-inflammatory results. So, be sort, and be superior.
Katie: I like that tidbit. That’s actually nice to find out about awe, and I’d guess others like gratitude and pleasure are nonetheless helpful. However that’s actually cool that they’ve truly 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 if you have a look at IL-6 ranges, that is what they determined to evaluate, awe works the very best. 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 now. 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 a giant fan, so I’ll put a hyperlink, folks can discover these. The whole lot we talked about will likely be at wellnessmama.fm. And Dr. Josh, thanks a lot to your time right now.
Josh: It was an actual pleasure, Katie. Thanks.
Katie: And thanks as at all times to you guys for listening and sharing your most beneficial assets, your time, vitality, and a spotlight with us right now. We’re each so grateful that you simply did, and I hope that you’ll be a part of me once more on the subsequent episode of the “Wellness Mama Podcast.”
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