August 19, 2022

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481: Dr. Joshua Levitt on Real Solutions for Musculoskeletal Pain

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Katie: Hello, and welcome to the “Wellness Mama Podcast.” I’m Katie from and 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 standard and pure drugs, he’s a naturopathic physician that has a very advanced, distinctive strategy to coping with musculoskeletal ache and orthopedic ache. And he talks in the present day about his wide-ranging strategy to this and why it’s way 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 strategy to care, the basis causes of ache, the mind-body connection that we are able to perceive by means of 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, which is a brand new firm. I’ve been utilizing a few of their merchandise and actually having fun with them. And we contact quite a bit on ache on this one, however he has experience in a number of completely different areas. I believe you’ll be taught quite a bit. So, let’s be part of Dr. Josh. Dr. Josh, welcome. Thanks for being right here.

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

Katie: Well, I’m tremendous excited to delve into your space of experience, however earlier than we get there, I’ve a 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 have now good waves in our space. So after this podcast, I can be taking a few of my children to log on in a hurricane. But I’ve a observe that if you happen to had been gonna give a TED speak, you’d speak about how browsing imitates life. So, I do know this might be a subject of its personal, however are you able to simply give us a pair excessive factors there, to start out off?

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

And so, you understand, a surfer looks as if a very good individual to speak to about that, proper? Well, it seems that in browsing, and I suppose it’s additionally true in life, there’s probably not something…there’s no static fastened level of stability, proper? Surfing is that this, like, ever motion, ever-fluid exercise that requires fixed type 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 actually not true. Instead 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 manner, and you progress the opposite manner. And I’d argue that in life, this concept, there’s a pursuit that lots of people are searching for, “I wanna find balance in my marriage, balance in my parenting, balance in my work, balance in my life.” And I form of wanna inform those that, like, take it from a surfer. There’s no such factor. There’s no fastened 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 form of like simply one of many bullet factors of my browsing imitates life speak. And, sure, we might go on and on.

Katie: I really like that. I hope you really try this as a chat at some point. And I agree with you. I’ve written about that too, that, like, stability is a transferring goal, and adaptableness is way more vital than discovering that fastened level typically.

Josh: Totally.

Katie: And additionally I wanna be certain we have now 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 effectively. But, to start out broad and form of perceive how you bought right here, I’ve a observe that you just went to UCLA on a pre-med monitor, and then you definitely pivoted. So, are you able to stroll us by means of what precipitated 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 kind of children who simply all the time wished to be a physician. So, it simply made sense. I studied neurophysiology at UCLA, and I had the nice fortune to type of, like, develop into 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 had been seeing the modifications afoot. Many of them have really come to go now, referring to insurance coverage corporations and large pharma and all that type of stuff. Life as a physician, as they used to understand it, wasn’t nearly as good, and they also had been saying, you understand, “I don’t know if you wanna do this. You know, it’s gonna just get worse.”

So I took that recommendation and took off, for a yr. This is form 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 understand, hitchhiking and touring all over the world with a backpack, sleeping in youth hostels, sleeping on seashores, all that type 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 mountaineering round, and heading to Europe, Switzerland, actually, and I had a blister on the again of my foot simply from, you understand, a number 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 downside. And so, I had the nice 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 manner 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 in the present day in lots of European pharmacies and locations all over the world, all these different medicines, proper? In addition to the antibiotics that I so desperately wanted on the time, I additionally noticed homeopathic medicines. I noticed natural teas, all this dietary stuff, nutritional vitamins, minerals, natural extracts and issues. And this was simply…possibly it’s as a result of I used to be form of, like, you understand, in a febrile, hallucinating state or one thing, however this was actually, actually eye-opening to me. It’s like, wow, there’s this entire 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 form 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 understand, which I’m very grateful for, nevertheless it opened my eyes to a complete world of medication that I didn’t know existed, and has since develop into my ardour, my profession, my life.

Katie: What a cool story. And I’ve an identical factor, like, I positively 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 instances that it’s saved my life as effectively. I believe that’s an vital 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 just phrased it that manner, what sort of sufferers, as a result of I all the time like to consider this. Even in distinction to the mainstream or standard drugs that we’re speaking about, sure, we are able to be glad about issues which have saved our lives, saved our limbs, however there’s additionally quite a bit to be realized from the pitfalls in Western drugs. And so, I believe the kind of affected person that I see, that’s form of like a basic query right here. So, for me, to start with, and most significantly, my sufferers are folks first, proper? I’ve by no means seen arthritis come strolling in my workplace, though I’ve seen a number of instances of it. I’ve by no means seen most cancers or thyroid illness. It’s all the time been, to this point in the present day, 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 vital distinction, and sadly typically will get misplaced in Western drugs.

We’re gonna speak about orthopedics and musculoskeletal ache, and it’s so frequent. I imply, anyone who’s been in 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 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, a number of my observe was dedicated to the care of individuals with musculoskeletal ache, however definitely not completely. And then one other type of philosophical level there’s 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 reside in Connecticut, proper down the highway 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 makes a speciality of thumbs, which is form of wonderful when you have a thumb downside, nevertheless it’s fairly simple to really feel like that’s, the blinders are on, and all you’re being handled for is that downside. So, my observe, though I had a reasonably important concentrate on orthopedics and musculoskeletal ache, was a observe that was just like the anti-specialty, or is a observe, it’s just like the anti-specialty. Whatever you bought, you’re a human. I understand how to deal with people, let’s go. And if we have to form of transfer on down the road to larger specialization, then that’s fantastic. But largely folks with musculoskeletal ache, and every part else, too, is my reply to that one.

Katie: I really like that reply as a result of, having been a affected person that I felt like was only a 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 fascinating in relation to ache as effectively, as a result of I really feel like as practical 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. Most of the folks I used to be working with understood the intestine connection, understood how the physique works as a complete. But it looks as if with ache, particularly with joints, there’s nonetheless possibly, such as you stated, some blinders there, that whereas we are able to take a look at the whole-body strategy in different areas, it’s typically a temptation to go, “Oh, you have a knee problem,” 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’d guess that there’s nonetheless, in fact, going to be whole-body connections there. So, how do you strategy somebody who is available in with a fancy case that possibly additionally has this musculoskeletal ache, or some form of orthopedic subject?

Josh: Yeah. And that’s an excellent query. I imply, you possibly can completely relate. Patients with thyroid issues are type of generally type of simply siloed into endocrinology. And, yeah, ache is a very tough one, quite a bit 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. But additionally they have ache, this mysterious sensation that we have now. I’d wish to type 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 in all probability earlier than, it’s intriguing, referred to as phantom limb ache. This is in an individual who’s an amputee, who doesn’t have a limb. Maybe they misplaced it in an accident or damage or regardless of the case could also be, and so they nonetheless have ache in that limb, or itching or different forms of sensations. Really tough to handle.

But it provides you this very fascinating 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 will not be within the foot, proper? It can’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. Well, they’ve a knee. It’s simply form of broken proper now, and so they have this ache, not not like the ache that the phantom limb affected person has. Is the ache within the knee? Well, 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. And then the mind grabs a maintain of those indicators 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 speak all about that, in and round an space infiltrated with blood and cells to assist heal. And there’s this entire 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? Again, it goes again to that basic philosophical standpoint. It’s an individual, proper? We have to know what tales they’ve round that ache, what it means to them, what they’re afraid of. A number of instances, there’s concern wrapped up in there. And then we have now to know diet, biomechanics, biochemistry, environmental drugs, together with toxicity and all the types of issues that practical and naturopathic docs speak about, occult infections, and all the opposite issues that would make one thing that’s traumatized or injured and in any other case painful much more painful. And I 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 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. But it feels like from what you’re saying, there’s a number of issues that might be performed in a different way and on completely different ranges that will actually change outcomes. So, let’s go deeper on that, and the way that might be performed in a different way.

Josh: Yeah, completely. And you’re proper. I imply, ache is taken into account now a significant signal, and, you understand, that was form of an concept that wound up form of being an enormous downside, 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 type of stuff. When the truth is the ache is a sign, proper? Pain is a sensation that we expertise, that our physique is telling us to vary our conduct. The most form 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 fireplace, the ache tells you that there’s one thing that should change, and that one thing is that it’s essential to transfer your hand away from the fireplace, proper? That’s nice. And that works very well. If you have got a thorn in your foot, you’ll limp to not press extra on that thorn, these types of issues. It’s a really primitive form 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 components like diet and whatnot.

So, the quick story of how…the genesis of any form of ache syndrome, I like to consider, like, you get up in the course of the evening to go use the lavatory or one thing and smash your toe towards 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, you understand, there’s injury to the realm. And it hurts. And then a complete bunch of issues begins to occur. Blood vessels opened up. Some tissue was broken. That tissue that was broken launched some chemical mediators from contained in the cells into the native bloodstream, after which the native bloodstream form of received sense…has sensors for these form of chemical substances which might be telling you that you just’ve been traumatized in a roundabout way. And that kicks off this superior, extraordinarily advanced cascade of interactions involving cytokines and leukotrienes, prostaglandins, and issues which might be all these chemical indicators that inform your immune system, basically, your white blood cells and all these cleanup cells, to say, “Hey, there’s something going on in that toe. Get on down there and start to clean up the mess.”

So, that’s what occurs. The white blood cells infiltrate the realm, and the cleanup crew begins. The level right here is that this inflammatory response, and we’ll get into irritation possibly even in additional element as we go alongside, is a mandatory a part of a therapeutic response. You have a, I consider a matrix of occasions that occurs, tissue damage, after which some ache, after which irritation, after which muscular rigidity across the space, some quantity of guarding, after which the therapeutic response. And irritation, which is a significant, main a part of the ache generator form of cascade, is a significant goal, the place we see extreme response based mostly on the extent of the damage, proper? So, many individuals who don’t eat effectively, who’re uncovered to environmental toxins, and many others., will smash that very same toe towards the tip desk and see a larger inflammatory response. And so, the extent of ache, the extent of irritation in response to an damage 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 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 smart. So, somebody with already a better diploma of irritation within the physique would have a heightened response to that acute irritation.

Josh: Absolutely. It doesn’t matter if it’s a mosquito chunk or if it’s an ACL tear in a snowboarding damage. An individual who’s more healthy will reply in a more healthy manner, with diminished 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 you additionally stated, like, that inflammatory response I’d guess really serves a vital function within the physique, in an acute sense, as a result of it’s releasing all of these signaling mechanisms, similar to there’s an inflammatory response post-exercise, that results in muscle progress. So that is…on the whole, irritation isn’t categorically a nasty factor, however you’re speaking about when we have now this systemically power irritation that then makes all of those responses worse?

Josh: Absolutely. It’s both systemically power 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 basic a part of type of human immunological reactions. If we didn’t have it, it might be lights out. It’s completely mandatory. And I believe, you understand, that is actually fascinating. Perhaps you understand this, or possibly not, that irritation, it has a Latin root phrase, like so many medical phrases. Inflammo means to set ablaze. It means fireplace. Inflammation is called after fireplace. And very very similar to fireplace, I imply, it’s a really aptly named course of. Fire is… Well, right here we’re, you understand, at a time when the world is burning up, particularly in California, you understand, these wildfires are so damaging. Fire is a large human development and basic to our survival, proper? We use it to cook dinner. We use it to remain heat. Harnessing fireplace was one of many best achievements of humankind.

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

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

Josh: Absolutely. I imply, yeah, the thought of suppressing irritation, you understand, form of a superb achievement by way of drugs, but in addition not with out danger, proper? This is a basic organic course of. I imply, you and I can each relate to this. If you have got any organic course of that’s type of been…that’s a part of form of our system and who we’re, and also you simply willy-nilly suppress that system, there’s gonna be penalties to that, proper? You can’t simply get away with that without end. And, sure, in fact, irrespective of which manner you resolve to suppress irritation, whether or not it’s from prednisone or steroids like that, or from the extra frequent lessons of over-the-counter medicines, non-steroidal anti-inflammatory medication, NSAIDs we name them, yeah, there’s gonna be a value to pay for that. So NSAIDs are, you understand, loaded with a complete host of negative effects, and steroids are much more highly effective anti-inflammatories which have much more highly effective negative effects.

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

Katie: That is smart. 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 smart that simply suppressing that with out determining the basis of it might be very counterproductive in the long run. And in my notes, you speak about a ache matrix, and form of another strategy to dealing with this, which I’m beginning to form of be capable of pull some items based mostly on what you’ve stated, however can we go into element on this, particularly for anybody who has, like, a power ache like this that they’re attempting to work by means of?

Josh: Yeah, completely. And I believe that is type of basic to the strategy. It’s one thing that advanced for me over time, form of like a circulation 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 have joints that damage. It is likely to be their neck or their shoulders or their again or their elbows, wrists, you understand, hips, knees, wherever the case could also be. They get lumped into this class referred to as arthritis, and once we look rigorously at these folks, there’s a type of a sample that emerges over years of caring for them on this type of naturopathic form of manner. First is, there’s one thing mistaken, proper? There’s one thing mistaken with the joint. It is likely to be that the cartilage is thinned out. It is likely to be that there’s bone spurring within the space. It is likely to be {that a} disc within the cervical or lumbar backbone is thinner than it’s speculated to be or is bulging out in a single place or one other.

So there’s some structural integrity. In most instances of people that have these sorts of issues, there’s one thing that’s structurally compromised. Very typically, 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 typically 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 thing. We see this joint space narrowing. There’s your problem,” proper? So, I’m right here to inform you that that’s not all the time true. In reality, fairly often, it’s not true. Structural downside is simply part of the story, as a result of, from that structural downside is that this entire matrix, this cascade of occasions that happens. The first, and one we began to simply scratch the floor on a bit bit, is when there’s structural issues, what does the physique do? Inflammatory response. Just like we described earlier than, this inflow of white blood cells, and there’s an inflammatory response. A wholesome inflammatory response, it’ll be graded in response to the extent of structural trauma or structural integrity issues. But if an individual has these underlying components, the inflammatory response is likely to be extreme. So 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. And then from there, that irritation is a set off for ache. It’s, you understand, form of an excellent system. You have a traumatized or structurally compromised space, you have got some irritation, you get a sign that it hurts. So you begin limping, otherwise you begin doing different form 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 frequent for folks 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 form 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.

Well, similar to irritation, there are circumstances that can lead folks to carry tighter and maintain longer than they need to with that muscular rigidity, and if that muscular rigidity persists, you wind up having muscular rigidity as a brand new ache generator, proper? So, right here we have now 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? And then, this persists, and right here we go, the final part of the matrix, is when this persists lengthy sufficient, the muscle rigidity cuts off blood provide, and as that blood provide is reduce off, the tissue turns into, oh, gosh, extra gristly, like, much less tender. You know, if you happen to consider a chunk of meat, if you happen to eat meat, you understand, there’s tender, and we form of normally like that. And then there’s, like, powerful, and we don’t like that an excessive amount of, a minimum of most individuals don’t.

And in case your muscle tissues are contracted and underneath rigidity, since you’re guarding them and holding for such a very long time, they’ll develop into 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 bundle is what hurts. And fairly often, if 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 smart. And you possibly can appropriate me if I’m mistaken on this, however I’ve heard that the structural factor doesn’t all the time essentially line up with the ache response in somebody who’s in any other case wholesome as effectively. Like, as an example, I’ve heard of instances, folks having a bulging disc or ruptured disc and never experiencing any ache. Whereas conversely, they’ve a minor subject and be experiencing an incredible quantity of ache.

Josh: You’re 100% proper. It’s simply wonderful to me, Katie, that extra docs don’t perceive this, or don’t even ask themselves that quite simple query that you just simply raised. Take a living proof. Here’s an individual. I simply had a case like this final week. He has again ache. You know, it didn’t go away. He went to a 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. And then, he did some stuff. He did some PT. You know, possibly 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 damage 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 understand, he simply doesn’t have the ache anymore. And that is extraordinarily frequent. So, this has been effectively studied. Your level is well-taken, and also you’re completely spot-on on this one.

The presence of imaging abnormalities, like arthritic modifications, joint area narrowing, disc bulges, degenerative modifications of any type, don’t correlate with a degree of ache. There’s a number of folks on the market who’ve every kind of badness and yucky-looking stuff on MRIs, and so they really feel fantastic. 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 all the time…I don’t wanna say that the structural factor is irrelevant, as a result of it’s there. It’s an actual factor. There’s not speculated to be a disc herniation. But, if there’s extreme irritation, muscle rigidity, fibrosis in and round that space, that’s the distinction between that disc herniation hurting and never hurting. And that’s essentially the most progressive ache management form 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 strategy to treating that in a form of a whole-person strategy, versus simply that acute trauma of the ache?

Josh: Yeah. So, and I believe speaking concerning the power 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 know, we had been simply speaking about how poorly imaging findings, X-rays and MRIs, correlate with ache, proper? But there are heaps and plenty of people that get informed by their radiologist or their orthopedist, and even proven these photos, proper? They say, “Hey, look here. You can see. See how it’s bulging out right there. That’s a problem. See how this is asymmetrical, and there’s a narrowing over here.” And sufferers fairly often have this picture. They’re not radiologists, they don’t know what they’re taking a look at, however they’ve a picture seared into their mind by a physician, you understand, an authority determine, telling them that they’re damaged. That’s what that story actually is telling them.

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

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

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

Katie: And, yeah, it looks as if a way more complete strategy 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 might have a tie-over into ache, and the plus facet right here being addressing all of these components, even if you happen to’re simply motivated initially by this acute ache, is gonna have such constructive spillover into so many different areas of life. Like, I really feel like altering that inflammatory response and getting it in a wholesome vary is gonna assist sleep, it’s gonna assist stress, it’s gonna assist digestion. Like, in fact, we all know the entire physique is linked.

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There’s lots of people on the market, particularly in relation to ache, I’m seeing lots of people utilizing various kinds of biohacking and entering into a few of these, like, extra obscure, or simply form of fringe concepts that I believe… My take is all the time there’s a time and a spot for lots of these issues, however I all the time like to inform folks, too, I believe 80% of it’s the stuff you’re doing every day, small habits, issues which might be free, your sleep, your stress, your meals, your motion. But I do additionally suppose there could be a time and a spot for these. But 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 employ any of these therapies, and in that case, how?

Josh: Yeah. I respect this query, and it’s an excellent one. And it’s virtually controversial a bit bit. I do know that world very effectively, like, the well being and wellness world, you understand, and the attraction to the brand new…you employ the phrase fringe. You know, the “progressive” is likely to be…you understand, we love shiny new objects on this nation, and that’s definitely no completely different on this planet of orthopedics and musculoskeletal ache. We additionally need to keep in mind that ache is a large motivator. Like, folks hate ache. They don’t wanna be in ache, and so they’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 employ the phrase “biohacker,” which is form of an entire group, a complete universe, actually, progressive medical stuff, may be very seductive, as a result of it makes these wild guarantees about this new science of injecting this or that.

And I utterly agree with you. I imply, I consider…and I’m gonna use a bit 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 have now for that. And me, and I think you is likely to be related, I wish to attempt to, like, open up the window and see if I can get him out. You know, I don’t just like the fly being in there. It’s an issue that I’ve, however I’m gonna attempt to use, like, a peaceable answer. And it generally works. There’s some dangers to it. It is likely to be a bit tougher. And then, I’d step it as much as, like, the rolled-up newspaper or the fly swatter, after which I’d step it up, though I in all probability wouldn’t, only for the sake of my metaphor right here, to, like, a chemical spray, like Raid or one thing. You might spray that across the kitchen and kill it. And then, 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 pressure that might be used to deal with an issue, on this case, the fly downside. I just like the least pressure. 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 pressure, 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 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 these may be nice, however they’re form of up in that greater 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. And then we go up from there. And, yeah, there is likely to be a time the place we’d like medicine or an injection of some type, and that is the place that biohacking universe begins up.

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

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

Katie: Yeah. It looks as if an vital form of development of the depth of therapies there. That was an excellent analogy. And I’ve all the time heard it stated that individuals solely change when the ache of staying the identical turns into larger than the ache of adjusting, and on this case, speaking about precise ache, it’s an exquisite trainer, to your level. And so, I’d guess for lots of people, you get to see them in an fascinating 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 in a position to then educate about all the methods wherein they’ll try this, that even when they find yourself needing at some point a kind of extra superior issues like surgical procedure, hopefully not, however their physique is gonna in all probability be in a significantly better state to deal with surgical procedure, or deal with no matter they want at some point, than if that they had not addressed these issues. Because as you had been speaking about this, I’m imagining, you understand, if somebody’s having…we’ve talked concerning the inflammatory connection right here and all of the layers of this. If somebody is in that state, going by means of surgical procedure is one other stress on the physique, is creating extra irritation and tissue injury within the physique, so their restoration from that may be fairly tough in the event that they haven’t addressed these different components.

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

And, yeah, for some folks, 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. But there’s many…I’d say not…I don’t know if I wanna say most. In my observe, I’d say, you understand, a big 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 way more gratifying might a profession be, to have the ability to assist folks keep away from these form of costly, scary interventions, and as an alternative use pure therapies? And, yeah, it’s unlucky that we have now to… It is. It’s very arduous to get folks to vary till there’s some cause that just about forces them. And, yeah, really, in a number of methods, makes my job simpler, proper? Here they’re. They’re able to go, you understand. So I simply assist usher them alongside that path.

Katie: And I’m positive it’s refreshing for them to work with somebody who will not be attempting to push them into the high-ticket, costly, and considerably drastic choices, but in addition deal with these root causes first. And I additionally suppose, 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 trainer, and it will get our consideration, and we are able to be taught a lesson, and hopefully, we do, in a manner 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 means of a mix of unusual and strange components, getting rhabdo. Which will not be a factor that will usually have occurred to me, however I had had blood loss after which a sequence of issues that form of compounded, and I received rhabdo. And the ache of that was sufficient to get my consideration. And positively, I used to be in a position to deal with some issues by means of that have and be taught classes about not pushing myself too arduous in sure areas, which had been vital to be taught.

But I believe if we reframe it, like, any form of ache, even emotional ache, there’s a number of metaphors there, turns into an excellent trainer if we let it. And if we don’t resist it, if we let it educate us, after which combine these habits and transfer ahead, and even for somebody who possibly doesn’t have a bulging disc or an ACL tear, and isn’t in acute ache, all of those stuff you’ve talked about, I’d guess, additionally enhance our resilience if we’re injured or if we encounter ache, as a result of if we deal with all this stuff beforehand, it might appear to be we are able to 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 gained’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 fantastic. So I hope that’s true. Yeah. The expertise of ache is a superb trainer certainly, and I believe that we reside in a world, society, definitely within the healthcare universe, the place we wanna simply suppress it. We need nothing to do with it, proper? We wanna keep forward of it so to talk, medicate it away, and we’re dropping quite a bit once we try this. Now, in fact, the ache is uncomfortable, proper? It’s uncomfortable for a cause, and when an individual is ready to type of take a pair deep breaths and form of go lean into that ache, that is what a number of the mindfulness work spearheaded by Jon Kabat-Zinn and so many others, you understand, about utilizing cognitive conduct remedy and mindfulness as pertains to ache, may be wonderful, highly effective instruments that don’t contain any change, you understand, in diet, however have radical influence on the biochemistry and the entire type of neurochemistry of ache.

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

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

Josh: Yeah. I do know your model with this query, and I really like this query. And my reply is a guide referred to as “Ferdinand the Bull.” And that may 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. Talk about ache. And it was proper at a time when all of the bullfight crew was coming in from Madrid to evaluate the bulls within the pasture, who was the most important, fiercest bull. He will get stung by a bee. He jumps up, he runs round loopy, and so they say, “Oh, we found our bull.” And they create Ferdinand the bull to go battle within the bullfights in Madrid, and all he ever desires to do is simply sit down in the course of the ring like he all the time did out within the pasture, and scent the flowers. He’s a peaceable, form bull. He doesn’t wanna battle. And that’s all the time been my favourite guide, and it stays my favourite guide 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 respect 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 folks discover you to continue to learn about your strategy and/or work with you if you’re taking new sufferers?

Josh: Thank you. Yeah. So, my observe, and proper now my observe is…I’m a busy individual, so my observe is full to new sufferers in the mean time. That can all the time change, relying on all types of various skilled and private life issues. My observe is right here in Hamden, Connecticut, and we have now 5 different docs there as effectively. That’s a observe referred to as Whole Health in Hamden, Connecticut. And the web site for our observe is 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. And the emblem of UpWellness is a wave. I informed you in the beginning I’m a surfer, and upwelling… This is an fascinating little facet observe for you. UpWellness is the identify of our firm, and our tagline is known as “Nutrient-Rich Living.”

So, any surfer can relate to this, or anybody who’s swum within the ocean or a big physique of water. There’s this phenomena the place you hit a chilly patch, and a chilly patch is an upwelling, the place there’s this upwelling of chilly, nutrient-dense water from 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’s additionally a nutrient-rich infusion, so therefore the identify of our firm, UpWellness, “Nutrient-Rich Living,” and 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

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

Josh: Great.

Katie: I’ll be certain folks can discover these. And any parting recommendation to depart with the viewers in the present day?

Josh: Oh, gosh, you understand, we’re…I believe, form of my tagline that I educate to my children that I attempt to, you understand, in all probability educate to myself as a lot as anyone, is simply to be form to one another. We are in a very difficult time, you understand, and I don’t wanna get into it, all of the division that’s on the market. But I believe that there’s just a few basic guidelines, and kindness might be on the high of that record that would assist a number of us, you understand, 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’d encourage folks to search for methods to search out awe, A-W-E, you understand, once more, a surfer phrase. We use the phrase superior, proper, after which surfers possibly co-opted that phrase to explain waves, or maneuvers on waves.

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

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

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

Katie: And that brings us full circle to our place to begin with browsing, and I positively realized quite a bit in the present day. I’m grateful for the work that you just 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, folks can discover these. Everything we talked about can be at And Dr. Josh, thanks a lot in your time in the present day.

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

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

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

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