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Katie: Hiya, 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 method to coping with musculoskeletal ache and orthopedic ache. And he talks at present about his wide-ranging method to this and why it’s far more than simply addressing the acute ache. And he talks about how he bought began as a naturopathic physician, the sufferers he works with and his method to care, the basis causes of ache, the mind-body connection that we will perceive by way 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 loads on ache on this one, however he has experience in a variety of totally different areas. I believe you’ll study loads. So, let’s be 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: Nicely, 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 midst of a tropical storm, which is the one time we now have 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 should you have been gonna give a TED speak, you’ll speak about how browsing imitates life. So, I do know this may very well be a subject of its personal, however are you able to simply give us a pair excessive factors there, to begin off?

Josh: Yeah, completely. Nicely, keep protected on the market, and, sure, hurricane waves are the very best waves. I do know it sounds loopy to individuals, when everybody else is eager to hunker down, surfers seize their boards and head outdoors. I can completely relate to that. So have enjoyable and keep protected on the market. Yeah, completely. I imply, someday, I’ll most likely form of develop a complete speak round this topic, browsing imitating life. Oh, my gosh, there’s a lot to say, proper? In all probability one of the frequent issues that comes up in my medical observe is about steadiness, and browsing and surfers, I believe, are form of just like the individuals who can be accused of getting actually good steadiness, proper? It’s a balance-intensive train, and so, , we speak loads about steadiness. And I’m certain, , it’s a topic that comes up, work-life steadiness, marital steadiness, , all these types of issues in steadiness and well being and wellness and conserving your self collectively.

And so, , a surfer looks like particular person to speak to about that, proper? Nicely, it seems that in browsing, and I suppose it’s additionally true in life, there’s not likely something…there’s no static fastened level of steadiness, proper? Browsing is that this, like, ever motion, ever-fluid exercise that requires fixed form of evaluation of what’s occurring 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 absolutely 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 might argue that in life, this concept, there’s a pursuit that lots of people are searching for, “I wanna discover steadiness in my marriage, steadiness in my parenting, steadiness in my work, steadiness in my life.” And I form of wanna inform folks 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 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 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 truly try this as a chat someday. And I agree with you. I’ve written about that too, that, like, steadiness is a shifting goal, and flexibility is far more necessary than discovering that fastened level typically.

Josh: Completely.

Katie: And in addition I wanna make certain we now have a variety 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. However, to begin broad and form of perceive how you bought right here, I’ve a observe that you simply went to UCLA on a pre-med monitor, and you then pivoted. So, are you able to stroll us by way of what brought about that change for you?

Josh: Yeah, completely. And, sure, we’ll spend the vast majority of our time on our content material, as a result of ache, I believe there’s only a few individuals who don’t find out about that, and who’ve an expertise in some kind or one other. Yeah. I used to be a kind of youngsters who simply all the time needed to be a health care provider. So, it simply made sense. I studied neurophysiology at UCLA, and I had the nice fortune to form of, like, turn out to be pleasant with, due to parental relationships, with a variety 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 have been seeing the modifications afoot. A lot of them have truly come to go now, regarding insurance coverage corporations and massive pharma and all that form of stuff. Life as a health care provider, as they used to comprehend it, wasn’t pretty much as good, and they also have been saying, , “I don’t know should you wanna do that. You realize, it’s gonna simply worsen.”

So I took that recommendation and took off, for a 12 months. That is form of what lots of people name a niche 12 months. After I completed UCLA, as a substitute of occurring to a graduate medical training, I simply took off for a 12 months, and this was me hair rising, , hitchhiking and touring world wide with a backpack, sleeping in youth hostels, sleeping on seashores, all that form of stuff. Anyway, the origin story, if you’ll, was, on this fateful flight, I used to be leaving from Israel, truly, the place I had been, and mountain climbing round, and heading to Europe, Switzerland, in reality, and I had a blister on the again of my foot simply from, , a variety of strolling in sandals and never nice hygiene, I’ve to confess, on the time. Anyway, that blister bought contaminated, and I knew sufficient to know that this was one thing critical. As I’m flying on this airplane, my leg is pink. I’m getting a fever. It’s creeping up my leg. I had cellulitis, which is a really critical medical drawback. And so, I had the nice fortune to have the ability to name in my individuals again dwelling. I bought 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 at present in lots of European pharmacies and locations world wide, 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 form of, like, , in a febrile, hallucinating state or one thing, however this was actually, actually eye-opening to me. It’s like, wow, there’s this complete drugs that’s not antibiotics and surgical procedure and all of the stuff that I knew of, and that was the start. Like, right here I’m now. It’s form of humorous to consider it this fashion. I’m, like, the naturopathic physician who bought his begin in a pharmacy the place I used to be choosing up a prescription for antibiotics, , 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 turn out to be 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 aspect 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 necessary caveat to recollect on this dialog. So, what sort of sufferers are you seeing now in your workplace once you’re working with individuals?

Josh: I’m glad that you simply phrased it that means, what sort of sufferers, as a result of I all the time like to consider this. Even in distinction to the mainstream or standard drugs that we’re speaking about, sure, we will be pleased about issues which have saved our lives, saved our limbs, however there’s additionally loads 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 begin with, and most significantly, my sufferers are individuals first, proper? I’ve by no means seen arthritis come strolling in my workplace, though I’ve seen a variety of circumstances of it. I’ve by no means seen most cancers or thyroid illness. It’s all the time been, up to now at present, 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 necessary 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 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 individuals as a result of they really feel like they’re simply their physique half, simply their illness, simply their gland, simply their sickness. And so, yeah, the primary a part of that reply is that they’re people. They’re sufferers. They’re individuals who have issues, in lots of circumstances, in my world, individuals who have ache. So, a variety of my observe was dedicated to the care of individuals with musculoskeletal ache, however definitely not completely. After which one other form of philosophical level there’s that if a health care provider like myself treats individuals, then I deal with the issues that these individuals have, which is, once more, very totally different than Western medical specialties. I stay in Connecticut, proper down the street from Yale. And at Yale, there’s hyper, hyper-focus on specialization, proper?

So, I’ve had, and I child you not, a affected person who had a really critical thumb drawback who went to see, not only a hand physician, however somebody who makes a speciality of thumbs, which is form of wonderful in case you have a thumb drawback, nevertheless it’s fairly simple to really feel like that’s, the blinders are on, and all you’re being handled for is that drawback. So, my observe, although 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. No matter 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 tremendous. However principally individuals with musculoskeletal ache, and every little thing else, too, is my reply to that one.

Katie: I really like that reply as a result of, having been a affected person that I felt like was only a prognosis when it got here to thyroid illness for a very long time, it’s actually superior to listen to a practitioner clarify it from that perspective. And it’s fascinating in terms of ache as effectively, as a result of I really feel like as purposeful and naturopathic drugs have gotten extra well-known, individuals are trying into extra root trigger approaches now. So, as an illustration, by the tip 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 like 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 typically 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 might guess that there’s nonetheless, in fact, going to be whole-body connections there. So, how do you method somebody who is available in with a fancy case that perhaps additionally has this musculoskeletal ache, or some form of orthopedic difficulty?

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

Nevertheless it offers you this very fascinating perspective once 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 shouldn’t be within the foot, proper? It might probably’t be, as a result of there isn’t a foot, proper? So, right here we now have our skier that we simply talked about, who tore their ACL. Nicely, they’ve a knee. It’s simply form of broken proper now, they usually have this ache, not not like the ache that the phantom limb affected person has. Is the ache within the knee? Nicely, it definitely was generated by constructions within the knee, however the ache is perceived within the mind, proper? It’s actually a mind drawback, and, yeah, it has its origins in a trauma within the knee. After which the mind grabs a maintain of those alerts which might be coming from a traumatized space, after which tells the particular person 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 fancy affected person with a ache dysfunction? Once more, it goes again to that basic philosophical standpoint. It’s an individual, proper? We’ve 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. After which we now have to know diet, biomechanics, biochemistry, environmental drugs, together with toxicity and all the kinds of issues that purposeful and naturopathic docs speak about, occult infections, and all the opposite issues that might make one thing that’s traumatized or injured and in any other case painful much more painful. And I believe that’s truly the important thing to debate right here is there’s so many individuals who’ve exaggerated reactions, be it irritation, or ache itself, past what their damage or trauma deserves, proper? And I believe there’s a lot room for serving to and therapeutic individuals 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 like 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 a variety of issues that may very well be completed in another way and on totally different ranges that will actually change outcomes. So, let’s go deeper on that, and the way that may very well be completed in another way.

Josh: Yeah, completely. And also you’re proper. I imply, ache is taken into account now an important signal, and, , that was form of an concept that wound up form of being a giant drawback, as a result of it initiated or was a part of the initiation of the opioid disaster that we now have now, treating ache, managing ache, staying forward of ache, all that form of stuff. When the fact is the ache is a sign, proper? Ache is a sensation that we expertise, that our physique is telling us to vary our habits. Probably the most form of primitive instance I can consider of that’s, like, in case your hand begins feeling actually, actually scorching as a result of it’s near a fireplace, the ache tells you that there’s one thing that should change, and that one thing is that that you must transfer your hand away from the hearth, proper? That’s nice. And that works very 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 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 elements like diet and whatnot.

So, the quick story of how…the genesis of any form of ache syndrome, I like to think about, like, you get up in the midst of the night time to go use the lavatory or one thing and smash your toe in opposition to the aspect of the tip desk there, toe will get crushed, proper? Some tissue will get broken within the space. Hopefully, you didn’t break a bone, however, , there’s 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 form of bought sense…has sensors for these form of chemical compounds which might be telling you that you simply’ve been traumatized indirectly. And that kicks off this superior, extraordinarily advanced cascade of interactions involving cytokines and leukotrienes, prostaglandins, and issues which might be all these chemical alerts that inform your immune system, primarily, 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 vital a part of a therapeutic response. You will have a, I consider a matrix of occasions that occurs, tissue damage, 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 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 in opposition to 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 straight correlated with the underlying biochemical well being of the person. So, that’s how I take into consideration these musculoskeletal pains, whether or not they come from trauma, acute damage like a ski accident, or from an autoimmune illness or a degenerative course of like arthritis, it’s all the identical.

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

Josh: Completely. It doesn’t matter if it’s a mosquito chew or if it’s an ACL tear in a snowboarding damage. An individual who’s more healthy will reply in a more healthy means, with lowered 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 damage like a trauma.

Katie: And also you additionally mentioned, like, that inflammatory response I might guess truly serves a vital objective 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 progress. So that is…usually, irritation isn’t categorically a nasty factor, however you’re speaking about when we now have this systemically persistent irritation that then makes all of those responses worse?

Josh: Completely. It’s both systemically persistent or extreme in response to trauma or an infection or damage. And the way in which I like to consider it…and, sure, you’re proper. The inflammatory response is a basic a part of form of human immunological reactions. If we didn’t have it, it could be lights out. It’s completely vital. And I believe, , that is actually fascinating. Maybe this, or perhaps not, that irritation, it has a Latin root phrase, like so many medical phrases. Inflammo means to set ablaze. It means fireplace. Irritation is known as after fireplace. And really very like fireplace, I imply, it’s a really aptly named course of. Fireplace is… Nicely, right here we’re, , at a time when the world is burning up, particularly in California, , these wildfires are so harmful. Fireplace is an enormous human development and basic to our survival, proper? We use it to prepare dinner. We use it to remain heat. Harnessing fireplace was one of many best achievements of humankind.

However fireplace can be extraordinarily harmful, maybe one of the 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 fireplace, we now have a giant drawback, proper? So, irritation is known as after fireplace, and correctly so. It’s vital. It’s basic. It’s truly crucial to our survival, however an excessive amount of is a nasty deal. And an excessive amount of will be, like, a low-lying persistent burn occurring on a regular basis, such as you talked about, a persistent inflammatory state, or it may be that the comb is so dry, there’s simply a lot tinder on the market, that when one thing occurs, a trauma, an damage, a mosquito chew, it flames up like that. And so, yeah, irritation is nice, however an excessive amount of shouldn’t be good.

Katie: After which it looks like a variety of the primary line of method to, like an damage particularly, or to ache, is a few sort of anti-inflammatory ache remedy. However I might guess since this isn’t addressing the basis explanation for the opposite irritation, and there are uncomfortable side effects to a variety of these medication, that may, in the long run, have a adverse impact, I might guess?

Josh: Completely. I imply, yeah, the concept of suppressing irritation, , form of an excellent achievement when it comes to drugs, but additionally not with out danger, proper? This can be a basic organic course of. I imply, you and I can each relate to this. You probably have any organic course of that’s form 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 may’t simply get away with that eternally. And, sure, in fact, regardless of which means you determine to suppress irritation, whether or not it’s from prednisone or steroids like that, or from the extra frequent lessons of over-the-counter drugs, non-steroidal anti-inflammatory medication, NSAIDs we name them, yeah, there’s gonna be a worth to pay for that. So NSAIDs are, , loaded with a complete host of uncomfortable side effects, and steroids are much more highly effective anti-inflammatories which have much more highly effective uncomfortable side effects.

So, the way in which that naturopathic docs like to consider that is to help the inflammatory course of, proper, slightly than suppress it. And, I believe, that’s a very enormous distinction between the way in which I observe drugs and form of purposeful integrative docs’ practices, help versus suppress. After all, there’s a time for suppression. When an individual’s life is in danger or limbs are in danger, , suppression will be vital. But when we take into consideration this as a hierarchical form of method, if there are methods to help a degenerative form of joint ache sort of syndrome, slightly than simply suppress, suppress, suppress irritation, the sufferers will nearly all the time be higher off in the long term.

Katie: That is sensible. And if ache is a messenger that’s telling us one thing in our mind, versus simply an acute response in a spot within the physique, it is sensible that simply suppressing that with out determining the basis of it may very well be very counterproductive in the long run. And in my notes, you speak about a ache matrix, and form of an alternate method to dealing with this, which I’m beginning to form 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 persistent ache like this that they’re attempting to work by way of?

Josh: Yeah, completely. And I believe that is form of basic to the method. It’s one thing that advanced for me over time, form of like a movement chart or a course of, or perhaps a sample recognition, for me, within the workplace watching individuals who undergo, lots of them…and simply as a broad class, we’ll name it arthritis, proper? They’ve joints that harm. It is likely to be their neck or their shoulders or their again or their elbows, wrists, , hips, knees, wherever the case could also be. They get lumped into this class referred to as arthritis, and once we look fastidiously at these individuals, there’s a form of a sample that emerges over years of caring for them on this form of naturopathic form of means. First is, there’s one thing unsuitable, proper? There’s one thing unsuitable 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 disc within the cervical or lumbar backbone is thinner than it’s alleged to be or is bulging out in a single place or one other.

So there’s some structural integrity. Generally 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 typically the one factor that the docs will inform the affected person is unsuitable, 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 inform you that that’s not all the time true. In actual fact, 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’s 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 response to the extent of structural trauma or structural integrity issues. But when an individual has these underlying elements, the inflammatory response is likely to 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 may very well be wholesome and well-controlled, or it may very well be uncontrolled like a wildfire. After which from there, that irritation is a set off for ache. It’s, , form of an excellent system. You will 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 form of habits change…postural modifications, fairly often involving muscle pressure. So, within the muscle tissue adjoining to the disc, or within the muscle tissue 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 individuals 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 form of maintain on to it. Like, you don’t wanna transfer it extra, and it’s a really clever physique response, proper? And when one thing’s torn or broken, you maintain on to it tighter.

Nicely, identical to irritation, there are situations that can lead individuals 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 now have a structurally compromised disc, some irritation within the space of the disc, now muscle pressure within the muscle tissue 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 minimize off, the tissue turns into, oh, gosh, extra gristly, like, much less tender. You realize, should you consider a bit of meat, should you eat meat, , there’s tender, and we form of often like that. After which 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 tissue are contracted and underneath pressure, since you’re guarding them and holding for such a very long time, they’ll turn out to be powerful, and that toughness is the results of the buildup of fibrin, like a scar tissue within the space, that makes the musculature much less tender, much less juicy, if you’ll. And so, that, that I simply described, from structural compromise to irritation to muscle pressure to fibrosis, that bundle is what hurts. And fairly often, once 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 massive of a deal.

Katie: That is sensible. And you’ll right me if I’m unsuitable 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 illustration, I’ve heard of circumstances, individuals having a bulging disc or ruptured disc and never experiencing any ache. Whereas conversely, they’ve a minor difficulty and be experiencing an amazing 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 realize, it didn’t go away. He went to a health care provider. He bought 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 realize, perhaps he took some remedy, no matter it was. It’s irrelevant. He did some stuff for a number of weeks, and he bought higher. So now his again doesn’t harm anymore. So, if…we’ll do a theoretical right here…we have been to shoot the MRI once more, he nonetheless has a disc herniation. So, , he simply doesn’t have the ache anymore. And that is extraordinarily 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 stage of ache. There’s a lot of individuals on the market who’ve all types of badness and yucky-looking stuff on MRIs, they usually really feel tremendous. And there’s all types of people that have horrible ache whose MRIs and X-rays look regular. So we can’t correlate imaging findings, X-ray, MRI, CT scan, to a medical syndrome. It simply doesn’t work, and the explanation why is the ache matrix that I simply described. It’s not 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 alleged 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 form of protocol on the market proper now, is to disregard the imaging findings. They don’t matter as a lot as most individuals assume they do.

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

Josh: Yeah. So, and I believe speaking in regards to the persistent stuff is extra related. And I’ll begin truly by going again to one thing that we mentioned earlier than, which was in regards to the expertise of the ache itself and the tales that we inform ourselves. You realize, we have been simply speaking about how poorly imaging findings, X-rays and MRIs, correlate with ache, proper? However there are tons and much of people that get instructed by their radiologist or their orthopedist, and even proven these photos, proper? They are saying, “Hey, look right here. You may 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 health care provider, , an authority determine, telling them that they’re damaged. That’s what that story actually is telling them.

In actual fact, 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 multitude,” proper? “I’m falling aside.” And that could be a very unlucky casualty of that dialog. So, one of many first issues that I begin with is by telling individuals, “Look, you’re not damaged. There’s tons of people that have disc herniations like that, they usually really feel completely tremendous. In actual fact, you’re gonna really feel completely tremendous in only a couple weeks, and also you’re nonetheless gonna have that disc herniation. So, you’re not damaged. You’re simply hurting. So let’s begin there,” proper? And that comes, , as an important aid to lots of people who actually really feel now that they’re damaged, in order that they should be cautious, they’ll’t run anymore, they’ll’t bike anymore, they’ll’t elevate up their youngsters or one thing like that, for concern that their damaged again is gonna actually turn out to be, , a much bigger drawback. 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, , reverse that story, to vary the channel, so to talk.

After which, there’s this complete world of choices that turn out to be obtainable to individuals, relying on the uniquenesses and the specifics of their very own case, that may, one, help the well being of the broken connective tissues. So, these are issues that about, Katie. These are issues that, like, are collagen, , a variety 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 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 nearly 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 help that integrity. In order that’s primary.

Quantity two is we attempt to help that inflammatory course of, lower the quantity of extreme irritation, with out suppressing irritation, however simply supporting it. So which means dietary modifications. We will get deeper on that if we…, there’s a lot. It’s mainly every little thing, actually, diet and way of life, that’s the distinction between a wholesome inflammatory response and an extreme one. So we go down that street with diet and dietary modifications, and natural medicines as applicable. After which if there’s muscle pressure concerned, I wish to work on that as effectively. And that may be labored on additionally nutritionally and biomechanically, postural re-education, bodily remedy, power, stretching, strengthening, set off level launch work, all these handbook issues that may be completed, lots of them with my very own fingers. After which relying on the chronicity, like how lengthy the issue has been occurring, and whether or not or not there’s proof of this scarification, , particularly in outdated accidents, we attempt to do what we will 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 like a way more complete method that will have optimistic ripples. I imply, the concept of irritation and out-of-control irritation being a root of many issues has come up on this podcast fairly a bit. It makes full sense that it could have a tie-over into ache, and the plus aspect right here being addressing all of these elements, even should you’re simply motivated initially by this acute ache, is gonna have such optimistic 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 related.

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There’s lots of people on the market, particularly in terms of ache, I’m seeing lots of people utilizing various kinds of biohacking and entering into a few of these, like, extra obscure, or simply 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 individuals, too, I believe 80% of it’s the stuff you’re doing each day, small habits, issues which might be free, your sleep, your stress, your meals, your motion. However I do additionally assume there could be a time and a spot for these. However I’m curious your tackle that, as a result of a variety of these do appear to line up with musculoskeletal or bodily efficiency. So, do you employ any of these therapies, and if that’s the case, how?

Josh: Yeah. I admire this query, and it’s an important one. And it’s nearly controversial somewhat bit. I do know that world very effectively, like, the well being and wellness world, , and the attraction to the brand new…you employ the phrase fringe. You realize, the “progressive” is likely to be…, we love shiny new objects on this nation, and that’s definitely no totally different on the planet of orthopedics and musculoskeletal ache. We additionally should do not forget that ache is a large motivator. Like, individuals hate ache. They don’t wanna be in ache, they usually’ll do something. They’ll spend some huge cash, they’ll do all types of loopy stuff to attempt to get out of ache. I believe it’s true that…you employ the phrase “biohacker,” which is variety of a complete 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 a variety of totally different choices that we now have 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 realize, 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 is likely to be somewhat tougher. 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 could possibly 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 concept right here is that, like, there’s growing ranges of power that may very well be used to deal with an issue, on this case, the fly drawback. I just like the least power. That’s the way in which I love to do it. And if that doesn’t work, we step it up. And with every growing stage of power, there’s growing ranges of toxicity or trauma to the kitchen, proper? Like, you pull out the flamethrower, there’s gonna be a giant mess. You’ll kill the fly actually successfully. And in orthopedics, we now have this on a regular basis, proper? We love surgical procedure. We love injections. We love prolotherapy, PRP, Lipogems, all of latest fancy stuff. And people will be nice, however they’re form 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 modifications, the approach to life modifications, posture, biomechanics, therapeutic massage, dietary remedy, natural remedy. That’s the opening the door or the window. After which we go up from there. And, yeah, there is likely to be a time the place we want remedy or an injection of some type, and that is the place that biohacking universe begins up.

We had prolotherapy was one of many early introductions, which was the injection of sugar molecules to assist spur or improve the expansion of cartilage cells. After which that advanced, and lots of people now are doing PRP, platelet-rich plasma injections, the place we extract the platelets, which have progress elements in there, form of a one-up to the outdated prolotherapy. After which up from there, we now have a bunch of fancy new peptides which might be obtainable, 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 should 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 form of work my means up that ladder, up that hierarchy. And so long as therapies are protected, and protected is each protected to the affected person, in fact, and likewise protected to their pocketbook… I believe there’s some huge cash to be made in a variety 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 particular person, and is likely to be efficient earlier than pulling out the flamethrower, then yeah, let’s go, . In order that’s the place I’m at with biohacking and novel progressive therapies.

Katie: Yeah. It looks like an necessary form of development of the depth of therapies there. That was an important analogy. And I’ve all the time heard it mentioned that folks 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 an exquisite trainer, to your level. And so, I might 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 the entire methods wherein they’ll try this, that even when they find yourself needing someday a kind 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 someday, than if they’d not addressed these issues. As a result of as you have been speaking about this, I’m imagining, , if somebody’s having…we’ve talked in regards to the inflammatory connection right here and all of the layers of this. If somebody is in that state, going by way 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 troublesome in the event that they haven’t addressed these different elements.

Josh: Yeah, completely. It was so eloquent the way in which you simply described that, Katie. It’s so true. That’s the place individuals are, proper? That’s the precipice that they’re on, “This drawback that I’ve is not acceptable to me.” They usually’re keen to do one thing about it, proper? And I believe the aim of the doctor, I imply, definitely, it’s not a means I’ve ever actually considered my job, however it’s, to form of assess, like, “All proper. Like, how problematic is that this? What are you keen to do? What modifications are you keen to make?” It’s definitely a dialogue that we all the time 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 circumstances, how a lot do you want that operating that you simply do, that’s simply messing up your knee? And I’ve had numerous folks that I’ve needed to say, , “I believe it is likely to be time to modify to a bicycle.” And it’s brutal. It’s a brutal actuality test for them to should assess, like, “Yeah. I’m on a precipice proper right here. I can’t cope with this hip state of affairs anymore. I’ve to make a change.”

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

Katie: And I’m certain it’s refreshing for them to work with somebody who shouldn’t be attempting to push them into the high-ticket, costly, and considerably drastic choices, but additionally handle these root causes first. And I additionally assume, if we will shift…since you talked about the mindset a few instances. 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 study a lesson, and hopefully, we do, in a means that has optimistic results. Going ahead, I do know for me, I’ll, like, get weak for a second. Just a few months in the past, I ended up, by way of 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 sequence of issues that form of compounded, and I bought rhabdo. And the ache of that was sufficient to get my consideration. And undoubtedly, I used to be in a position to handle some issues by way of that have and study classes about not pushing myself too onerous in sure areas, which have been necessary to study.

However I believe if we reframe it, like, any form of ache, even emotional ache, there’s a variety of metaphors there, turns into an important 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 perhaps 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 might guess, additionally enhance our resilience if we’re injured or if we encounter ache, as a result of if we handle 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 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 like you’re doing simply tremendous. So I hope that’s true. Yeah. The expertise of ache is a good trainer certainly, and I believe that we stay in a world, society, definitely 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 shedding loads once we try this. Now, in fact, the ache is uncomfortable, proper? It’s uncomfortable for a purpose, and when an individual is ready to form of take a pair deep breaths and form of go lean into that ache, that is what a variety of the mindfulness work spearheaded by Jon Kabat-Zinn and so many others, , about utilizing cognitive habits remedy and mindfulness as pertains to ache, will be wonderful, highly effective instruments that don’t contain any change, , in diet, however have radical influence on the biochemistry and the entire form of neurochemistry of ache.

And completely, I believe, we have to take it for what it’s value. You realize, completely, if it’s disabling or incapacitating, there’s instruments that we now have and we should always be pleased about to assist handle that. However, sure, it’s certainly a lesson, a trainer, and there’s all the time, and I might say all the time, I imply, we don’t get to say that too typically in drugs, tales that we now have which might be borne of our personal experiences, that inform what our expertise is of that ache. And so, if, , your life historical past tells a sure story, and you then come up in opposition to some form of ache, you’ll take that ache expertise, and it’ll turn out to be 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 form of naturopathic administration to a ache syndrome, whether or not it’s a persistent drawback or an acute drawback, is that the evaluation of that story, and attempting to assist individuals discover methods to reframe it in a means that makes it a optimistic expertise for them in the end.

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 e-book or a variety of books which have had a profound influence in your life, and if that’s the case, what they’re and why?

Josh: Yeah. I do know your type with this query, and I really like this query. And my reply is a e-book referred to as “Ferdinand the Bull.” And that could be a child’s e-book that I’ve a number of copies of. It was my favourite e-book as a baby, and it stays my favourite e-book as an grownup. It’s the story of Ferdinand the bull, who bought stung by a bee. Speak about ache. And it was proper at a time when all of the bullfight crew was coming in from Madrid to evaluate the bulls within the pasture, who was the largest, fiercest bull. He will get stung by a bee. He jumps up, he runs round loopy, they usually say, “Oh, we discovered our bull.” They usually deliver Ferdinand the bull to go struggle within the bullfights in Madrid, and all he ever desires to do is simply sit down in the midst of the ring like he all the time did out within the pasture, and odor the flowers. He’s a peaceable, variety bull. He doesn’t wanna struggle. And that’s all the time been my favourite e-book, and it stays my favourite e-book 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 admire the query and the recollections it evokes.

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

Josh: Thanks. Yeah. So, my observe, and proper now my observe is…I’m a busy particular person, so my observe is full to new sufferers in the mean time. That may 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 now have 5 different docs there as effectively. That’s a observe referred to as Entire Well being 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 brand of UpWellness is a wave. I instructed you initially I’m a surfer, and upwelling… That is an fascinating little aspect observe for you. UpWellness is the identify of our firm, and our tagline is known as “Nutrient-Wealthy Dwelling.”

So, any surfer can relate to this, or anybody who’s swum within the ocean or a big physique of water. There’s this phenomena the place you hit a chilly patch, and a chilly patch is an upwelling, the place there’s this upwelling of chilly, nutrient-dense water from under, that replaces the nutrient-depleted water above, the place all of the organic exercise is, from the solar and the fish and whatnot. And so, that higher layer of water will get depleted, after which currents and whatnot will trigger this infusion from under of chilly water, and we expertise that as a chilly patch. Nevertheless it’s additionally a nutrient-rich infusion, so therefore the identify of our firm, UpWellness, “Nutrient-Wealthy Dwelling,” and is the place individuals will discover all of the merchandise that we create that assist individuals with musculoskeletal ache and all method of different totally 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: Nice.

Katie: I’ll make certain individuals can discover these. And any parting recommendation to go away with the viewers at present?

Josh: Oh, gosh, , we’re…I believe, form of my tagline that I educate to my youngsters that I attempt to, , most likely educate to myself as a lot as anyone, is simply to be variety to one another. We’re in a very difficult time, , and I don’t wanna get into it, all of the division that’s on the market. However I believe that there’s just a few basic guidelines, and kindness might be on the high of that checklist that might assist a variety of us, , get alongside higher and resolve a few 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 might encourage individuals to search for methods to seek out awe, A-W-E, , once more, a surfer phrase. We use the phrase superior, proper, after which surfers perhaps co-opted that phrase to explain waves, or maneuvers on waves.

However superior is one thing that, , makes us really feel small, makes us really feel humble, makes us notice 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 totally different optimistic 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 optimistic feelings, together with issues like pleasure and contentment and different optimistic feelings. Awe is essentially the most highly effective optimistic emotion when it comes to anti-inflammatory results. So, be variety, and be superior.

Katie: I really like that tidbit. That’s actually nice to find out about awe, and I might guess others like gratitude and pleasure are nonetheless useful. 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 useful, for certain, like gratitude, love, pleasure, all clearly useful, however once 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 loads at present. 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, individuals can discover these. All the pieces we talked about will likely be at And Dr. Josh, thanks a lot on your time at present.

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

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

Should you’re having fun with these interviews, would you please take two minutes to go away a score or evaluate on iTunes for me? Doing this helps extra individuals to seek out the podcast, which suggests much more mothers and households may benefit from the data. I actually admire your time, and thanks as all the time for listening.

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