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Dr. Joshua Levitt on Actual Options for Musculoskeletal Ache

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Katie: Good day, and welcome to the “Wellness Mama Podcast.” I’m Katie from 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 typical 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 received began as a naturopathic physician, the sufferers he works with and his method to care, the foundation causes of ache, the mind-body connection that we will perceive via understanding issues like phantom limb ache, understanding irritation and the way it pertains to ache, and a lot extra. He’s additionally the founding father of, which is a brand new firm. I’ve been utilizing a few of their merchandise and actually having fun with them. And we contact lots on ache on this one, however he has experience in quite a lot of totally different areas. I believe you’ll be taught lots. 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: Effectively, I’m tremendous excited to delve into your space of experience, however earlier than we get there, I’ve a word in my present notes that you’re a surfer. And I’m at present in the midst of a tropical storm, which is the one time we’ve 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 word that in the event you have been gonna give a TED discuss, you’d discuss how browsing imitates life. So, I do know this could possibly be a subject of its personal, however are you able to simply give us a pair excessive factors there, to start out off?

Josh: Yeah, completely. Effectively, keep protected on the market, and, sure, hurricane waves are the very best waves. I do know it sounds loopy to folks, when everybody else is desirous to hunker down, surfers seize their boards and head outdoors. I can completely relate to that. So have enjoyable and keep protected on the market. Yeah, completely. I imply, at some point, I’ll in all probability sort of develop an entire discuss round this topic, browsing imitating life. Oh, my gosh, there’s a lot to say, proper? In all probability some of the widespread issues that comes up in my medical follow is about steadiness, and browsing and surfers, I believe, are sort of just like the individuals who can be accused of getting actually good steadiness, proper? It’s a balance-intensive train, and so, you recognize, we discuss lots about steadiness. And I’m positive, you recognize, it’s a topic that comes up, work-life steadiness, marital steadiness, you recognize, all these types of issues in steadiness and well being and wellness and preserving your self collectively.

And so, you recognize, a surfer looks as if a very good individual to speak to about that, proper? Effectively, it seems that in browsing, and I suppose it’s additionally true in life, there’s probably not something…there’s no static 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 a surfer is at any level balanced is actually not true. As an alternative 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 approach, and you progress the opposite approach. And I might argue that in life, this concept, there’s a pursuit that lots of people are on the lookout for, “I wanna discover steadiness in my marriage, steadiness in my parenting, steadiness in my work, steadiness in my life.” And I sort of wanna inform people who, 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 discover ways to successfully handle the imbalance, and also you’ll be a lot better off, in order that’s sort of like simply one of many bullet factors of my browsing imitates life discuss. And, sure, we might go on and on.

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

Josh: Completely.

Katie: And likewise I wanna ensure that we’ve quite a lot 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 start out broad and sort of perceive how you bought right here, I’ve a word that you simply went to UCLA on a pre-med monitor, and then you definately pivoted. So, are you able to stroll us via what precipitated that change for you?

Josh: Yeah, completely. And, sure, we’ll spend the vast majority of our time on our content material, as a result of ache, I believe there’s only a few individuals who don’t learn about that, and who’ve an expertise in some type or one other. Yeah. I used to be a kind of youngsters who simply all the time wished to be a physician. So, it simply made sense. I studied neurophysiology at UCLA, and I had the great fortune to form of, like, turn into pleasant with, due to parental relationships, with quite a lot 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. Lots of them have truly come to go now, regarding insurance coverage firms and massive pharma and all that form of stuff. Life as a physician, as they used to understand it, wasn’t pretty much as good, and they also have been saying, you recognize, “I don’t know in the event you wanna do that. You already know, it’s gonna simply worsen.”

So I took that recommendation and took off, for a yr. That is sort of what lots of people name a spot yr. After I completed UCLA, as an alternative of happening to a graduate medical training, I simply took off for a yr, and this was me hair rising, you recognize, 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 climbing round, and heading to Europe, Switzerland, in truth, and I had a blister on the again of my foot simply from, you recognize, quite a lot 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 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 great fortune to have the ability to name in my folks again house. I received a prescription for antibiotics, known as right into a pharmacy in Zurich, Switzerland, and I hobbled my approach in there in a feverish state, and took antibiotics, which saved my life, or at very least, saved my leg.

And in that pharmacy, I noticed, like you’ll nonetheless see 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 sort of, like, you recognize, in a febrile, hallucinating state or one thing, however this was actually, actually eye-opening to me. It’s like, wow, there’s this complete drugs that’s not antibiotics and surgical procedure and all of the stuff that I knew of, and that was the start. Like, right here I’m now. It’s sort of humorous to consider it this manner. I’m, like, the naturopathic physician who received his begin in a pharmacy the place I used to be choosing up a prescription for antibiotics, you recognize, which I’m very grateful for, but it surely opened my eyes to an entire world of drugs that I didn’t know existed, and has since turn into my ardour, my profession, my life.

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

Josh: I’m glad that you simply phrased it that approach, what sort of sufferers, as a result of I all the time like to consider this. Even in distinction to the mainstream or typical 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 lots to be realized from the pitfalls in Western drugs. And so, I believe the kind of affected person that I see, that’s sort of like a 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 quite a lot of circumstances of it. I’ve by no means seen most cancers or thyroid illness. It’s all the time been, thus far 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 usually will get misplaced in Western drugs.

We’re gonna discuss orthopedics and musculoskeletal ache, and it’s so widespread. I imply, anyone who’s been in an enormous factory-like orthopedic workplace can know the sensation of, like, you’re “the knee in room six,” otherwise you’re the “hip in room seven.” And that’s actually irritating to folks as a result of they really feel like they’re simply their physique half, simply their illness, simply their gland, simply their sickness. And so, yeah, the primary a part of that reply is that they’re people. They’re sufferers. They’re individuals who have issues, in lots of circumstances, in my world, individuals who have ache. So, quite a lot of my follow was dedicated to the care of individuals with musculoskeletal ache, however actually not completely. After which one other form 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 totally different than Western medical specialties. I stay 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 critical thumb drawback who went to see, not only a hand physician, however somebody who focuses on thumbs, which is sort of superb if in case you have a thumb drawback, but it surely’s fairly straightforward to really feel like that’s, the blinders are on, and all you’re being handled for is that drawback. So, my follow, despite the fact that I had a reasonably vital give attention to orthopedics and musculoskeletal ache, was a follow that was just like the anti-specialty, or is a follow, it’s just like the anti-specialty. No matter you bought, you’re a human. I understand how to deal with people, let’s go. And if we have to sort of transfer on down the road to higher specialization, then that’s high quality. However largely folks with musculoskeletal ache, and every little thing else, too, is my reply to that one.

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

Josh: Yeah. And that’s an awesome query. I imply, you possibly can completely relate. Sufferers with thyroid problems are form of generally form of simply siloed into endocrinology. And, yeah, ache is a very difficult one, lots to say right here. I imply, actually, if somebody twists their knee and tears their ACL snowboarding, they do, they’ve a knee drawback, proper? That’s fairly clear. However additionally they have ache, this mysterious sensation that we’ve. I’d prefer to form of share one thing that everyone can relate to, and I can relate to this, not personally, however professionally, having had sufferers who’ve suffered with this. There’s this drawback that we’ve all heard of in all probability earlier than, it’s intriguing, known as phantom limb ache. That is in an individual who’s an amputee, who doesn’t have a limb. Possibly they misplaced it in an accident or harm or regardless of the case could also be, and so they nonetheless have ache in that limb, or itching or different forms of sensations. Actually tough to handle.

However it offers you this very attention-grabbing perspective while you simply give it some thought, proper? If an individual doesn’t have a foot, and their foot that they don’t have hurts, it’s fairly clear that the ache 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’ve our skier that we simply talked about, who tore their ACL. Effectively, they’ve a knee. It’s simply sort 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? Effectively, it actually 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 indicators which can 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 stress and fibrosis, and we will discuss all about that, in and round an space infiltrated with blood and cells to assist heal. And there’s this complete story, an emotional half.

So, ache, gosh, it’s actually one thing. And so, your query was how do I 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 occasions, there’s concern wrapped up in there. After which we’ve to know diet, biomechanics, biochemistry, environmental drugs, together with toxicity and all the types of issues that useful and naturopathic docs discuss, occult infections, and all the opposite issues that might make one thing that’s traumatized or injured and in any other case painful much more painful. And I believe that’s truly the important thing to debate right here is there’s so many individuals who’ve exaggerated reactions, be it irritation, or ache itself, past what their harm or trauma deserves, proper? And I believe there’s a lot room for serving to and therapeutic folks in that house, in that delta.

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

Josh: Yeah, completely. And also you’re proper. I imply, ache is taken into account now an important signal, and, you recognize, that was sort of an concept that wound up sort of being an enormous drawback, as a result of it initiated or was a part of the initiation of the opioid disaster that we’ve now, treating ache, managing ache, staying forward of ache, all that form of stuff. When the truth is the ache is a sign, proper? Ache is a sensation that we expertise, that our physique is telling us to alter our habits. Probably the most sort of primitive instance I can consider of that’s, like, in case your hand begins feeling actually, actually scorching as a result of it’s near a hearth, 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 fireplace, proper? That’s nice. And that works rather well. In case you have a thorn in your foot, you’ll limp to not press extra on that thorn, these types of issues. It’s a really primitive sort of response. And but, like, there’s all these tales that get wrapped up in it, and in addition, it will get enhanced or elevated by all of those underlying baseline elements like diet and whatnot.

So, the quick story of how…the genesis of any sort of ache syndrome, I like to think about, like, you get up in the midst of the evening to go use the toilet 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 recognize, there’s injury to the world. And it hurts. After which an entire bunch of issues begins to occur. Blood vessels opened up. Some tissue was broken. That tissue that was broken launched some chemical mediators from contained in the cells into the native bloodstream, after which the native bloodstream sort of received sense…has sensors for these sort of chemical substances which can be telling you that you simply’ve been traumatized not directly. And that kicks off this superior, extraordinarily advanced cascade of interactions involving cytokines and leukotrienes, prostaglandins, and issues which can 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 one thing happening in that toe. Get on down there and begin to clear up the mess.”

So, that’s what occurs. The white blood cells infiltrate the world, and the cleanup crew begins. The purpose right here is that this inflammatory response, and we’ll get into irritation perhaps even in additional element as we go alongside, is a vital a part of a therapeutic response. You’ve got a, I consider a matrix of occasions that occurs, tissue harm, after which some ache, after which irritation, after which muscular stress across the space, some quantity of guarding, after which the therapeutic response. And irritation, which is a serious, main a part of the ache generator sort of cascade, is a serious goal, the place we see extreme response primarily based on the extent of the harm, proper? So, many individuals who don’t eat effectively, who’re uncovered to environmental toxins, and so on., will smash that very same toe towards the tip desk and see a higher inflammatory response. And so, the extent of ache, the extent of irritation in response to an harm 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 harm like a ski accident, or from an autoimmune illness or a degenerative course of like arthritis, it’s all the identical.

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

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

Katie: And also you additionally stated, like, that inflammatory response I might guess truly serves a vital function within the physique, in an acute sense, as a result of it’s releasing all of these signaling mechanisms, identical to there’s an inflammatory response post-exercise, that results in muscle development. So that is…normally, irritation isn’t categorically a nasty factor, however you’re speaking about when we’ve this systemically power irritation that then makes all of those responses worse?

Josh: Completely. It’s both systemically power or extreme in response to trauma or an infection or harm. 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, you recognize, that is actually attention-grabbing. Maybe you recognize this, or perhaps not, that irritation, it has a Latin root phrase, like so many medical phrases. Inflammo means to set ablaze. It means hearth. Irritation is called after hearth. And really very like hearth, I imply, it’s a really aptly named course of. Fireplace is… Effectively, right here we’re, you recognize, at a time when the world is burning up, particularly in California, you recognize, these wildfires are so damaging. Fireplace is a large human development and basic to our survival, proper? We use it to prepare dinner. We use it to remain heat. Harnessing hearth was one of many biggest achievements of humankind.

However hearth can also be extraordinarily damaging, maybe some of the damaging forces on the planet, and so irritation could be very a lot the identical. Like, we love a candlelit dinner, but when the candle catches the curtains on hearth, we’ve an enormous drawback, proper? So, irritation is called after hearth, and correctly so. It’s vital. It’s basic. It’s truly essential to our survival, however an excessive amount of is a nasty deal. And an excessive amount of could be, like, a low-lying power burn occurring 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 harm, a mosquito chunk, 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 as if quite a lot of the primary line of method to, like an harm particularly, or to ache, is a few kind of anti-inflammatory ache treatment. However I might guess since this isn’t addressing the foundation reason for the opposite irritation, and there are unintended effects to quite a lot of these medication, that may, in the long run, have a unfavorable impact, I might guess?

Josh: Completely. I imply, yeah, the concept of suppressing irritation, you recognize, sort of a superb achievement by way of drugs, but in addition not with out danger, proper? This can be a basic organic course of. I imply, you and I can each relate to this. In case you have any organic course of that’s form of been…that’s a part of sort of our system and who we’re, and also you simply willy-nilly suppress that system, there’s gonna be penalties to that, proper? You possibly can’t simply get away with that ceaselessly. And, sure, after all, regardless of which approach you resolve to suppress irritation, whether or not or not it’s from prednisone or steroids like that, or from the extra widespread courses of over-the-counter medicines, non-steroidal anti-inflammatory medication, NSAIDs we name them, yeah, there’s gonna be a worth to pay for that. So NSAIDs are, you recognize, loaded with an entire host of unintended effects, and steroids are much more highly effective anti-inflammatories which have much more highly effective unintended effects.

So, the way in which that naturopathic docs like to consider that is to assist the inflammatory course of, proper, reasonably than suppress it. And, I believe, that’s a very big distinction between the way in which I follow drugs and sort of useful integrative docs’ practices, assist versus suppress. After all, there’s a time for suppression. When an individual’s life is in danger or limbs are in danger, you recognize, suppression could be vital. But when we take into consideration this as a hierarchical sort of method, if there are methods to assist a degenerative sort of joint ache kind of syndrome, reasonably 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 foundation of it could possibly be very counterproductive in the long run. And in my notes, you discuss a ache matrix, and sort of another method to dealing with this, which I’m beginning to sort of have the ability to pull some items primarily based on what you’ve stated, however can we go into element on this, particularly for anybody who has, like, a power ache like this that they’re attempting to work via?

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

So there’s some structural integrity. Normally of people that have these sorts of issues, there’s one thing that’s structurally compromised. Fairly often, and I’d like to get into this extra later, that structural compromise is seen on X-ray or on MRI, and could be very usually the one factor that the docs will inform the affected person is fallacious, proper? “Oh, we see this structural compromise. We see this bone spur. We see this disc factor. We see this joint house narrowing. There’s your drawback,” proper? So, I’m right here to let you know that that’s not all the time true. In actual fact, fairly often, it’s not 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 keeping with the extent of structural trauma or structural integrity issues. But when an individual has these underlying elements, the inflammatory response could be extreme. In order that’s the primary a part of the ache matrix after the structural drawback.

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

Effectively, identical to irritation, there are situations that can lead folks to carry tighter and maintain longer than they need to with that muscular stress, and if that muscular stress persists, you wind up having muscular stress as a brand new ache generator, proper? So, right here we’ve a structurally compromised disc, some irritation within the space of the disc, now muscle stress within the muscle groups throughout that disc, and now issues are actually beginning to damage, proper? After which, this persists, and right here we go, the final part of the matrix, is when this persists lengthy sufficient, the muscle stress 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 already know, in the event you consider a bit of meat, in the event you eat meat, you recognize, there’s tender, and we sort of normally like that. After which there’s, like, powerful, and we don’t like that an excessive amount of, at the least most individuals don’t.

And in case your muscle groups are contracted and underneath stress, since you’re guarding them and holding for such a very long time, they will turn 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 stress to fibrosis, that bundle is what hurts. And fairly often, while you deal with all of these different accent issues, particularly the irritation, muscle stress, 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 fallacious on this, however I’ve heard that the structural factor doesn’t all the time essentially line up with the ache response in somebody who’s in any other case wholesome as effectively. Like, as an example, I’ve heard of circumstances, folks having a bulging disc or ruptured disc and never experiencing any ache. Whereas conversely, they’ve a minor challenge and be experiencing an incredible quantity of ache.

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

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

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

Josh: Yeah. So, and I believe speaking concerning the power stuff is extra related. And I’ll begin truly by going again to one thing that we stated earlier than, which was concerning the expertise of the ache itself and the tales that we inform ourselves. You already know, 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 informed by their radiologist or their orthopedist, and even proven these photographs, proper? They are saying, “Hey, look right here. You possibly can see. See the way it’s bulging out proper there. That’s an issue. See how that is asymmetrical, and there’s a narrowing over right here.” And sufferers fairly often have this picture. They’re not radiologists, they don’t know what they’re , however they’ve a picture seared into their mind by a physician, you recognize, 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 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 damaged, that my again is degenerated, that I’m a multitude,” proper? “I’m falling aside.” 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 damaged. There’s tons of people that have disc herniations like that, and so they really feel completely high quality. In actual fact, you’re gonna really feel completely high quality in only a couple weeks, and also you’re nonetheless gonna have that disc herniation. So, you’re not damaged. You’re simply hurting. So let’s begin there,” proper? And that comes, you recognize, as an awesome aid to lots of people who actually really feel now that they’re damaged, so that they must be cautious, they will’t run anymore, they will’t bike anymore, they will’t elevate up their youngsters or one thing like that, for concern that their damaged again is gonna actually turn into, you recognize, a much bigger drawback. I believe Western drugs, mainstream drugs does an enormous disservice to sufferers sort of unintentionally, by telling them or implying that they’re broken, and it’s unlucky that that occurs. So, we begin there, attempt to, you recognize, reverse that story, to alter the channel, so to talk.

After which, there’s this complete world of choices that turn into accessible to folks, relying on the uniquenesses and the specifics of their very own case, that may, one, assist the well being of the broken connective tissues. So, these are issues that you recognize about, Katie. These are issues that, like, are collagen, you recognize, quite a lot 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 can 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 assist that integrity. In order that’s primary.

Quantity two is we attempt to assist that inflammatory course of, lower the quantity of extreme irritation, with out suppressing irritation, however simply supporting it. So meaning dietary modifications. We will get deeper on that if we…you recognize, there’s a lot. It’s principally 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 highway with diet and dietary modifications, and natural medicines as acceptable. After which if there’s muscle stress concerned, I prefer 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 performed, lots of them with my very own arms. After which relying on the chronicity, like how lengthy the issue has been happening, and whether or not or not there’s proof of this scarification, you recognize, particularly in previous accidents, we attempt to do what we will to interrupt up that fibrosis that’s sort of the scar tissue, that toughness in a muscle or delicate tissues round an affected joint. And that’s the bundle.

Katie: And, yeah, it looks as if a way more complete method that might 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 facet right here being addressing all of these elements, even in the event 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, after all, we all know the entire physique is related.

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There’s lots of people on the market, particularly on the subject of ache, I’m seeing lots of people utilizing various kinds of biohacking and moving into a few of these, like, extra obscure, or simply sort 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 can be free, your sleep, your stress, your meals, your motion. However I do additionally suppose there generally is a time and a spot for these. However I’m curious your tackle that, as a result of quite a lot 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 respect this query, and it’s an awesome one. And it’s nearly controversial somewhat bit. I do know that world very effectively, like, the well being and wellness world, you recognize, and the attraction to the brand new…you employ the phrase fringe. You already know, the “progressive” could be…you recognize, we love shiny new objects on this nation, and that’s actually no totally different on the planet of orthopedics and musculoskeletal ache. We additionally must keep in mind that ache is a big 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 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 form of an entire group, an entire 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 quite a lot of totally different choices that we’ve for that. And me, and I believe you could be related, I prefer to attempt to, like, open up the window and see if I can get him out. You already know, I don’t just like the fly being in there. It’s an issue that I’ve, however I’m gonna attempt to use, like, a peaceable resolution. And it typically works. There’s some dangers to it. It could 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 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 may 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 pressure that could possibly be used to deal with an issue, on this case, the fly drawback. 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 growing degree of pressure, there’s growing 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’ve this on a regular basis, proper? We love surgical procedure. We love injections. We love prolotherapy, PRP, Lipogems, all of latest fancy stuff. And people could be nice, however they’re sort of up in that 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 life-style 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 could be a time the place we want treatment or an injection of some kind, and that is the place that biohacking universe begins up.

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

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

Katie: Yeah. It looks as if an necessary sort of development of the depth of therapies there. That was an awesome analogy. And I’ve all the time heard it stated that folks solely change when the ache of staying the identical turns into higher than the ache of adjusting, and on this case, speaking about precise ache, it’s a beautiful instructor, to your level. And so, I might guess for lots of people, you get to see them in an attention-grabbing level the place they’re hitting that threshold of it’s now extra painful to remain the identical, they’re keen to alter, and also you’re capable of then educate about all the methods by which they will 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 a lot 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. As a result of as you have been speaking about this, I’m imagining, you recognize, if somebody’s having…we’ve talked concerning the inflammatory connection right here and all of the layers of this. If somebody is in that state, going via surgical procedure is one other stress on the physique, is creating extra irritation and tissue injury within the physique, so their restoration from that is also fairly tough in the event that they haven’t addressed these different elements.

Josh: Yeah, completely. It was so eloquent the way in which you simply described that, Katie. It’s so true. That’s the place individuals are, proper? That’s the precipice that they’re on, “This drawback that I’ve is now not acceptable to me.” And so they’re keen to do one thing about it, proper? And I believe the aim of the doctor, I imply, actually, it’s not a approach 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 actually a dialogue that we all the time have, like, how a lot do you want your present weight loss plan? How a lot do you want your present inactive way of life? Or, in some circumstances, how a lot do you want that working that you simply do, that’s simply messing up your knee? And I’ve had numerous people who I’ve needed to say, you recognize, “I believe it could be time to modify to a bicycle.” And it’s brutal. It’s a brutal actuality test for them to must assess, like, “Yeah. I’m on a precipice proper right here. I can’t take care of this hip state of affairs anymore. I’ve to make a change.”

And, yeah, for some folks, meaning I’m able to have a surgeon minimize me open and take my previous 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 follow, I’d say, you recognize, 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 folks keep away from these sort of costly, scary interventions, and as an alternative use pure therapies? And, yeah, it’s unlucky that we’ve to… It’s. It’s very exhausting to get folks to alter till there’s some motive that just about forces them. And, yeah, truly, in quite a lot of methods, makes my job simpler, proper? Right here they’re. They’re able to go, you recognize. So I simply assist usher them alongside that path.

Katie: And I’m positive 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 in addition handle these root causes first. And I additionally suppose, if we will shift…since you talked about the mindset a few occasions. I believe if we shift our mindset, we will have excessive gratitude when there’s ache, as a result of it’s an unimaginable instructor, and it will get our consideration, and we will be taught a lesson, and hopefully, we do, in a approach that has optimistic results. Going ahead, I do know for me, I’ll, like, get susceptible for a second. A number of months in the past, I ended up, via a mix of unusual and weird elements, getting rhabdo. Which isn’t a factor that might usually have occurred to me, however I had had blood loss after which a collection of issues that sort of compounded, and I received rhabdo. And the ache of that was sufficient to get my consideration. And positively, I used to be capable of handle some issues via that have and be taught classes about not pushing myself too exhausting in sure areas, which have been necessary to be taught.

However I believe if we reframe it, like, any sort of ache, even emotional ache, there’s quite a lot of metaphors there, turns into an awesome instructor if we let it. And if we don’t resist it, if we let it educate us, after which combine these habits and transfer ahead, and even for somebody who 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 improve our resilience if we’re injured or if we encounter ache, as a result of if we handle all this stuff beforehand, it could seem to be we will deal with these issues higher in the event that they happen. Is that your expertise as effectively?

Josh: Yeah, completely. I imply, first, to your factor, and we received’t spend any extra time on it apart from me to say I hope it was a speedy and full restoration for you. It looks as if you’re doing simply high quality. So I hope that’s true. Yeah. The expertise of ache is a good instructor certainly, and I believe that we stay in a world, society, actually within the healthcare universe, the place we wanna simply suppress it. We would like nothing to do with it, proper? We wanna keep forward of it so to talk, medicate it away, and we’re shedding lots after we try this. Now, after all, the ache is uncomfortable, proper? It’s uncomfortable for a motive, and when an individual is ready to form of take a pair deep breaths and sort of go lean into that ache, that is what quite a lot of the mindfulness work spearheaded by Jon Kabat-Zinn and so many others, you recognize, about utilizing cognitive habits remedy and mindfulness as pertains to ache, could be superb, highly effective instruments that don’t contain any change, you recognize, 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 price. You already know, completely, if it’s disabling or incapacitating, there’s instruments that we’ve and we should always be pleased about to assist handle that. However, sure, it’s certainly a lesson, a instructor, and there’s all the time, and I might say all the time, I imply, we don’t get to say that too usually in drugs, tales that we’ve which can be borne of our personal experiences, that inform what our expertise is of that ache. And so, if, you recognize, your life historical past tells a sure story, and then you definately come up towards some sort of ache, you’ll take that ache expertise, and it’ll turn into a part of your story. And that may make it damage roughly, relying on what your background is and what tales you’re telling your self about it. And so, I believe that as a part of a complete form of naturopathic administration to a ache syndrome, whether or not it’s a power drawback or an acute drawback, is that the evaluation of that story, and attempting to assist folks discover methods to reframe it in a approach that makes it a optimistic expertise for them in the end.

Katie: I like that. And as we get near the tip of our time, just a few questions I like to ask, the primary being if there’s a ebook 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 model with this query, and I like this query. And my reply is a ebook known as “Ferdinand the Bull.” And that may be a child’s ebook that I’ve just a few copies of. It was my favourite ebook as a toddler, and it stays my favourite ebook as an grownup. It’s the story of Ferdinand the bull, who received 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, and so they say, “Oh, we discovered our bull.” And so they convey Ferdinand the bull to go combat 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 scent the flowers. He’s a peaceable, form bull. He doesn’t wanna combat. And that’s all the time been my favourite ebook, and it stays my favourite ebook to today. It’s nearly, I don’t know, peace, smelling flowers, and non-violence. I simply love “Ferdinand the Bull.” So I respect the query and the recollections it evokes.

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

Josh: Thanks. Yeah. So, my follow, and proper now my follow is…I’m a busy individual, so my follow is full to new sufferers in the meanwhile. That may all the time change, relying on all types of various skilled and private life issues. My follow is right here in Hamden, Connecticut, and we’ve 5 different docs there as effectively. That’s a follow known as Complete Well being in Hamden, Connecticut. And the web site for our follow is You’ll see me there. I’m nonetheless there. I simply am at this actual second not accepting new sufferers proper now. I additionally am the medical director of an organization known as UpWellness, which is discovered at,, UpWellness. And the emblem of UpWellness is a wave. I informed you at first I’m a surfer, and upwelling… That is an attention-grabbing little facet word for you. UpWellness is the title of our firm, and our tagline is known as “Nutrient-Wealthy Residing.”

So, any surfer can relate to this, or anybody who’s swum within the ocean or a big physique of water. There’s this phenomena the place you hit a chilly patch, and a chilly patch is an upwelling, the place there’s this upwelling of chilly, nutrient-dense water from beneath, that replaces the nutrient-depleted water above, the place all of the organic exercise is, from the solar and the fish and whatnot. And so, that higher layer of water will get depleted, after which currents and whatnot will trigger this infusion from beneath of chilly water, and we expertise that as a chilly patch. However it’s additionally a nutrient-rich infusion, so therefore the title of our firm, UpWellness, “Nutrient-Wealthy Residing,” 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 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 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 ensure that folks can discover these. And any parting recommendation to depart with the viewers at present?

Josh: Oh, gosh, you recognize, we’re…I believe, sort of my tagline that I educate to my youngsters that I attempt to, you recognize, in all probability educate to myself as a lot as anyone, is simply to be form to one another. We’re in a very difficult time, you recognize, 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 quite a lot of us, you recognize, get alongside higher and remedy among the nice world issues if we simply saved kindness on the entrance of our minds. And past that, there’s one different factor, and I’ll share this with you, too, is that I might encourage folks to search for methods to seek out awe, A-W-E, you recognize, once more, a surfer phrase. We use the phrase superior, proper, after which surfers perhaps co-opted that phrase to explain waves, or maneuvers on waves.

However superior is one thing that, you recognize, makes us really feel small, makes us really feel humble, makes us notice that the world is that this larger place that we’re part of. It’s the oneness. And it seems, closing notes right here, that scientists have studied all these 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 probably the most highly effective optimistic emotion by way of anti-inflammatory results. So, be form, and be superior.

Katie: I like that tidbit. That’s actually nice to learn 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. And so they’re all useful, for positive, like gratitude, love, pleasure, all clearly useful, however while you take 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 positively realized lots 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 an enormous fan, so I’ll put a hyperlink, folks can discover these. Every little thing 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 sources, your time, vitality, 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 following episode of the “Wellness Mama Podcast.”

Should you’re having fun with these interviews, would you please take two minutes to depart a ranking or overview on iTunes for me? Doing this helps extra folks to seek out the podcast, which implies 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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