Treating the Root Cause of Chronic Pain and Dysfunction with Dr. Jeff Johnson- Episode 59

Do you sit all day at work or suffer from chronic pain? This week we speak with Dr. Jeff Johnson, DC, to answer all of these questions and more. Dr. Johnson works with patients to “move past their pain” by utilizing the best chiropractic, soft tissue therapy, and rehabilitative exercises.

If you need help treating your chronic pain, click here.
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Topics:
Episode Intro…..2:47
Jeff Johnson Bio…..3:25
Athletic Injuries…..4:24
Sitting and Imbalances…..11:56
Unlocking the Zip Ties…..17:19
Imaging Studies, Dysfunction and Pain…..20:14
Non-invasive vs. Surgical Interventions…..25:15
Dr. Johnson’s Method…..30:45
Episode Wrap-up…..39:51

Links:

41:22 http://www.trusalus.com

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Treating the Root Cause of Chronic Pain and Dysfunction with Dr. Jeff Johnson

Dr. Michael Ruscio: Hey, everyone. This is Dr. Ruscio without your fast facts, but with a question about the fast facts. I’m not really sure if the fast facts are something that people find very helpful or just kind of eh. So if you would really do me a favor and let me know if you think they’re really helpful and we should continue with them, or if they are something that are not really necessary. I would really appreciate it.

They take a fair amount of time to put together. And as my schedule just continues to get tighter and tighter and tighter, I’m trying to consolidate it to the things that are only the most beneficial for everyone.

So, happy to keep doing them if they are helpful. If they’re not really something that people are getting much out of, then I will gladly take one more thing off of my very full plate. So please let me know. Any method of communication is fine. The comments section associated with this post would be fine, or social media, or Twitter, or what have you.

So please let me know and we’ll listen on this for a couple of weeks, and then make a decision. All right. Thanks, guys. Bye.

Hey, folks. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. I am here with my good friend, Dr. Jeff Johnson, probably one of the best looking doctors here in the Walnut Creek area. Hey, Jeff, welcome to the show.

Dr. Jeff Johnson: Well, thank you, Mike. And that’s a really nice introduction. I appreciate that. Thank you.

DrMR: You and I met, was it five or six years ago now?

DrJJ: Well, I think it’s been at least that much time, yes. It’s been about five years ago we met in Danville.

Episode Intro

DrMR: Yeah. So we’ve been together for a while in terms of knowing each other. I actually worked out of Jeff’s office for the first maybe six months that I was out of school. Jeff has a really successful—I’ll just try to give it whatever generic name and you can correct me in a minute—but he has a really successful kind of rehabilitation office where he does some chiropractic, some soft tissue work, some really great soft tissue work.

And why I wanted to get him on today was because we haven’t really talked much about the whole rehab, musculoskeletal system balance. If you’re struggling with a shoulder injury, a knee injury, a hip injury, what is or are some things that you can do for that?

We talk a lot about internal health, especially a lot about gut and thyroid. But I thought it might be fun to bring on someone who really is day in and day out seeing people with chronic structural issues and has a really good track record with those. So that’s why I’m glad to have Jeff here.

Jeff, can you give people kind of a brief synopsis of your training and what you’re doing now?

Jeff Johnson Bio

DrJJ: Yeah, absolutely. Well, I’ve been in practice for almost 20 years now, which I have a hard time saying. I can’t believe it’s been almost 20 years, but I still feel youthful on the inside. So over the course of 20 years when you first come out of school, you’re very excited. But you also have very limited experience as far as working with the human body.

Obviously, the curriculum is very much developed. And what do you do if you get this scenario? And they always I think a lot of times try to give you the worst case scenario to make sure that you’re taking good care of people, but also giving them what they need if it’s not going to be with your services.

But I think what is missed largely in school is the conversation of just the commonality you’re going to see. What are the most common factors that you’re going to see in most injuries? What is happening to everybody? I would say for instance, we can talk about all parts of the body, whether it’s shoulder injuries, hip injuries.

Athletic Injuries

DrJJ: But let’s just talk about athletic injuries for a second. For those of your people listening who are out there whether you’re a professional athlete, you are a person who used to play collegiate sports or high school sports and now you have a career, you have kids and you’ve been pulled away from, not only sport, but a lot of the supportive activity, the practices, maybe the time with the team when you stretch and/or do other types of conditioning activities.

What’s happened over a period of time with your body? Well, in school I think we’re taught to study injuries from the perspective of visualize the athlete on the soccer field who’s running down and gets the slide tackle and gets taken out. And there’s a ballistic trauma that happens to one part of the body. Tissues are injured. Let’s just say that hopefully all of that’s involved, but some tissues get injured. They’re disrupted.

What does that process look like and what’s the fastest case scenario for rehabbing that person? So there are some tried and true protocols for that. But the reality is that’s not the injury or that’s not the scenario that most people from day-to-day deal with with the musculoskeletal system.

Most people on a day-to-day basis are dealing with the deconditioning components that come about from their inactivity in and around their events. And so the people who are athletic and who are in the workplace and working, and then have some time, maybe a couple of times a week to go do extended runs, or they’re cycling, or maybe they’re on an indoor soccer team, they’re having these athletic events as really periods of time where an injury might be presenting itself.

But the injury that’s presenting itself is not that ballistic injury that we talked about. It’s usually an injury that kind of comes off like a nagging hamstring. Their shoulder’s not right when they’re playing. And they’re trying to throw the ball. They’re starting to get some shoulder pain.

Most people when they come in, cannot relate one specific injury or one specific incident that triggered any event. So what I found over many years, is that we start asking the question, “Well, what’s happening with the human body”?

And what’s usually happening is that I see…And I think we can kind of break these two parts up when we do our physical examinations we look at the body holistically. But to get into the intricacies of the different protocols we would run, we really like to start at the naval and work our way up. Or work at the naval and work our way down.

And the reason we do that is because with the thousands of bodies I’ve touched over the years, it’s virtually impossible in most scenarios to separate the dysfunction that comes from, let’s say for instance, the surgical spine of a person’s neck, from their shoulder or shoulder girdle because the movements and the machinery, so to speak, or the muscles and the joints and the complexity of it, is such that if a person has discrepancies in motion coming from the shoulder, they’re almost certainly going to have discrepancies in motion in the cervical spine.

So what we like to do is try to educate people on a concept that I call in the practice…Our goal is to get someone neutral. And what I mean by that is that we’re trying to get a person to where their shoulder girdles and their hips are neutral so that they can fully contract and relax into any plan of action.

So if we were to use the hip, for instance, it’s very, very common for someone to come into a chiropractor’s office and relating that they have low back pain or hip pain or sciatica. If you work with a lot of athletes you will hear them say that they have IT Band syndrome or they have plantar fasciitis, posterior tibia tendonitis.

So all these different things, you have runner’s knee, swimmer’s shoulder. There’s all these names for different body parts. But what usually you’re going to see is that because of deconditioning or the body being put into prolonged postures…So if we were to talk about the professional, let’s say you have a successful lawyer who is logging in their 50, 60 hours a week of work and then trying to power out some workouts around that, what they don’t realize is that they’re sitting for prolonged periods of time day after day, year after year, with their hips flexed into one position or posture, which is hip flexion.

And when that happens, the muscles that support that plan of action get offloaded and begin to shorten. We call that facilitation. So they begin to shorten. And not only do they contract out tissues, the muscles start to become weak and deconditioned and shorter, but it’s the noncontract out tissue, the fasciitis the structured matrix that supports moving it and moving integrity, it also begins to shorten. And when that happens it happens very, very slowly over time.

And what a person doesn’t realize is that they no longer can move their hips through full plains of range of motion. They actually become very efficient at being that seated posture. And when that happens, over time it sets into a sequence of events where they start to compensate in many different ways. There’s lots of different ways it happens. But they start to compensate and start to use their bodies in ways that it wasn’t designed to move to get the same outcome that they were getting before. And then they start to develop the secondary injuries around that loss of motion. And, again, that can happen anywhere.

So if we were to look at using this example of the lawyer who’s logging long hours and sitting, this lawyer then got up and said “I’m going to go knock-out 100 miles this week, or maybe a 150 miles on my bike this week. And I’ll get some long rides in.” And they’re trying to be competitive with their cycling. And they go out there and they do an activity that puts them back into more flexion. And they are bent forward. And they’re hammering on their bike, hour after hour out there, reinforcing, basically, their shorten injury patterns.

When they go to standup straight and get off their bike, their body is not capable of standing in a neutral poster because they have some muscle groups that have become so physiologically shortened that the opposing muscle groups now are at a disadvantage.

So what we look to do in our examinations in this scenario is we look to lay a person down on the table. We have them standing. We have them standing on one leg. We do a lot of different postures and positions to identify, number one and first and foremost is, which tissues have become accommodated or short and are creating an anchoring activity, almost like a zip tie.

Picture a zip tie that’s gone too short and it creates an anchoring. If you don’t go through and identify where the zip ties are, so to speak, and the hips and the legs and release those shorten tissues, then no other opposing range of emotion can take place. And as a result of that, you’re going to have seriously compromised biomechanical function. You’re going to have pain, inflammation, and potentially a whole host of other issues.

DrMR: So you make a lot of great points. And, gosh, where do I want to go next with this?

Sitting and Imbalances

DrMR: So one of the things that I think everyone’s heard about is that prolonged sitting is not good for you and can definitely create imbalances. And I think there are different schools of thought in terms of how do we rectify these imbalances.

Of course, one could be better ergonomics at the workplace. Having a standing desk, for example, and certainly these things I think make sense. But there may be a lot of people out there that have limitations there. So they may not be able to totally optimize where they’re working ergonomically. So then there are things like stretching and strengthening the exercises.

And it sounds like the thing that you’re trying to identify first is—and please correct me if I’m wrong—but maybe before you try to strengthen a muscle that’s weak, you’re trying to unblock the opposing muscle that’s too short and preventing the other muscle from functioning properly. Would that be an accurate restatement?

DrJJ: So I think you’ve actually restated beautifully. I couldn’t agree with that statement more. So I’ll give you an example of that. You have a young adolescent who’s been sitting hour after hour in their classroom, day after day after day. They’re walking around carrying heavy backpacks. Picture the slumped shoulder, head forward, a 13-year-old.

Now, this kid develops some pain in the neck and the shoulders. And it doesn’t even matter who they go to see. But the reality is there’s a couple of different opposing philosophies that are going to be addressed in this. First, one way to look at that is well, we have a child in pain. And we just want to make the pain go away so we can give them a prescription medication. Probably not the best choice because it doesn’t do anything to address the underlining biomechanical aberrancy.

The second thing you can say is, someone with a trained eye might look at that say “Wow, those shoulders and that head is really slumped forward because they’ve got some weakness and tone imbalance coming from between the shoulder blades. And what we want to do is we want to get them to start doing some exercises to really start firing off those muscles on the back of the shoulders, that are going to then tighten and contract and pull them upright.”

Another school of thought would be that if a person that has forward slumped shoulders, could there be something that is literally anchoring them into that position. That would be more of the zip tie scenario that I gave you with the hip.

So in my practice, what I’ve learned over many years is that I have a philosophy and a methodology that I articulate is this. When your shoulders are slumped forward and your head is jutted forward and you’re in a great deal of pain we understand and foremost goal is to get out of pain.

But the reality is that if we first don’t unzip and unlock those zip ties in the frontal shoulder by lengthening that tissue out so that you have the ability to be neutral, it really doesn’t matter how many exercises we give you in the post year component there to contract and hold you there because the muscles in the back will never be strong enough to overcome shortened fascial structures that have developed from offloading or I should say bad posture.

So what we do is we put first things first. And we have a methodology where the very first thing we do is we identify the shorten tissues. And what we want to do is allow a person to go through with some at-home stretches, the manual therapies, and the stretching that we do. We go through a process where we link in all the shorten tissue so that the person has the ability to sit upright in their body with their head neutral, their shoulders are neutral, and be there.

The second thing we also understand, though, is if we leave a person in this space and then we don’t at this point reintroduce some strengthening exercises and some movement exercises, we’re going to miss two things. And that is this. Number one, when you’ve had your head forward and your shoulders locked forward for an extended period of time, neurologically your body starts to identify that as its new self-image And it will start to hold you there. That’s a neurological fact, number one.

Number two, what will happen is your body becomes very efficient in creating a new movement pattern. So what you want to do is as you’re lengthening these tissues out and restoring the body’s ability to be neutral, you then want to have under a watchful eye a person doing rehabilitative exercises that are not only designed to re-strengthen the tissues that have become weak as a result of the posture, but you also want them to be going through mobility and stability exercises that retrain them how to move correctly because if a person leaves your office feeling better but still moving with the incorrect patterns, the injury is going to rapidly come back, anyway.

So then what we do is once we get through that stability phase, then we get to take a person right back to where everyone wants to be, which is in their power phase, moving joyously, kind thoughtlessly, in the activities that they like to do as an athlete.

DrMR: Got you. Okay.

Unlocking the Zip Ties

DrMr: And we talked about kind of the first phase to be unlocking the zip ties, so to speak. Is there a name for this? Because let’s say there’s someone listening to this who’s saying, “Gosh, this sounds like me. This is something I really want to seek out.” What would you tell someone to look for to try to find someone locally to help them with this?

DrJJ: So what I would say to that is that this area and this philosophy that I’m laying out right now. First of all, I can tell you wholeheartedly that this is the practitioner of the future. And this type of philosophy and methodology will be working its way into being more in front line center. But there a couple of techniques out there.

I was trained by a doctor named Dr. Peter Levy, who taught me in the technique called neuromuscular reeducation. And the philosophy was how to take individual shortened tissues and to use multiple techniques one time to take shorten tissues and to rehab them into their full length and full stability and obviously regain the strength component.

There are also other doctors who have created the same philosophy, other different methodologies. And so an example of that would be a very popular technique would be called active release technique. So there are active release technique practitioners and neuromuscular reeducation practitioners.

The bottom line is that all of us are largely trying to accomplish the same goal. We might learn slightly different variants in our techniques. But the philosophy is very much the same. And what I would suggest is that going through the training it’s like anything else. And healthcare is no different than picking, again saying a lawyer or a psychologist or any other professional.  You’re going to get some good ones and you’re going to get some bad ones. What you have to be willing to do is understand that this philosophy is very successful.

And when you use a practitioner who is active release technique certified or neuromuscular reeducation certified, that doesn’t necessarily mean that they’re the best practitioner. You want to find somebody who’s going to be able to give you and deliver you results with great confidence. Most of the injuries we work with have some pretty realistic timeframes. And the types of turnaround that we have with our injuries, I can assure you, is a fraction of the time that other practitioners around us using different types of philosophies.

But the practitioners who are really good doing ART or really good doing NMR for neuromuscular reeducation, they’re going to be able to deliver you a pretty reasonable outcome in a very reasonable amount of time.

Non-invasive vs. Surgical Interventions

DrMR: I got you. Okay, so a couple of follow-up questions I’d like to ask on that. I have a friend in mind. And I’d like to ask a few questions, kind of on his behalf because I’m sure, this being a real-world example it might resonate with some people.

So he was told that he has microtears in, I believe, the muscles of his rotator cuff. And one thing I remember back from school…Again, being fairly far removed from the rehab scene for many, many years. So this may have changed. But I remember one of the things learning in school was that the results that you see on imaging findings don’t always correlate to dysfunction, meaning you can have two people with the same findings on an X-ray or an MRI. One of those people can be in pain. The other person could be functioning just fine.

So I guess that would be the first part of the question is have you found that to be true, A? And then, B, where would you start if someone came in with a chronic shoulder injury saying that they’ve been told they can’t really do much lifting or exercising with their shoulder because of those findings on the imaging study?

DrJJ: Well, I would say that probably the majority of the time, the area that the person comes in pointing to, so to speak, and saying, “It’s right here. It hurts right here,” they almost always have inflammation at that point. And there’s no doubt. But is that origin, is the point of pain also the point of origin for the injury? And usually it’s not.

Could we go back to the scenario where, again we talk about the soccer player who get side tackled? Okay, you get a cleat in the side of the leg. And there’s a big bruise and discoloration in the tissue. And, of course, we know that that’s the site of injury.

But we have most people that come in are pointing at something that develops over time. And usually the point of pain is a point of the heaviest amount of compensation. And that compensation is coming about because other tissues somewhere else are not doing what they’re supposed to be doing for different reasons.

So most of the time we find that the discrepancy in location of pain versus the origin of the pain are two different places, for sure. And what I would also tell you is that while MRI is very, very important I rarely refer out for MRI and/or for x-ray because the proper physical examination of soft tissues is usually not needed.

And the cases that I do refer out for is because I have not been able to deliver an expected outcome in an expected amount of time. And therefore I will refer out for MRI and for a surgical consult with one of the orthopedists I use in the area and/or a neurosurgical consult of the spine.

But, again, the people that come with me with MRIs who have been around the block, the MRI is just another piece of information. And so there can be, in some cases, a high level correlation if it’s the direct blow to the one spot. But in other cases the correlation of the MRI, I find is going to be very low.

DrMR: Got you. Yeah, that’s one of the things I was a little bit concerned with regarding my friend’s case because micro tears are usually the result of

repeat trauma. And repeat trauma, there’s probably altered biomechanics in the joint, meaning that not ideal intervention would be, “Well, you just can’t use the joint.”

The new intervention would be how can we fix the biomechanics, the zip tie muscle in the front end and repeating the muscles in the backend, so to speak? How can we fix that so that there’s no more trauma to the joint every time you move?

And my concern—and I’m hoping to get my friend to come over and see you—is that he works as a medical device sales rep. He sells medical drills and saws to surgeons. And so I was afraid that he was getting a bit of a surgically biased perspective, which I think there’s nothing wrong with that. That’s one opinion to get in a few opinions so that you have a care plan.

And I always have to look at these things kind of in a hierarchical fashion. And, of course, we would put something like surgery or avoidance of using a joint at the end of the list. And at the top of the list would be something more like what you do, which is to look into imbalances from sitting all day or from driving in a car all day and those imbalances causing altered biomechanics in the joint and then that causing repeat trauma to the muscle or the joint tissue. That can then be a rehab being repaired and allow one to function properly.

So I’m hoping to get my friend in to see you because, again, I think you got a good opinion from someone. But there’s an old adage that if all you have is a hammer, everything looks like a nail. So that’s why I’m a little bit concerned about the surgical consult opinion on this.

DrMR: Yeah, I think that’s a good thing. I think that’s a good concern from the standpoint of this. Number one, the majority of people, maybe 5% of our patients get referred out for a second opinion. I mean maybe. And the reason I say that, number one is in your friend’s scenario, he’s seen worst case scenario. Only a fraction of the people out there actually need to go onto getting a surgical intervention of what you’re talking about when the reality is the vast majority of people have issues that can be quickly and succinctly dealt with if they’re seeing the right person with the right approach.

And they’re going to be able to do that for pennies on the dollar. The average person comes into our office. Let’s say, for the hands-on therapy they come in for eight to ten sessions. You’re talking about $800 dollars. If a person allows a dysfunction to go on for years and they go get a surgery for their shoulders, well now you’re talking about $30,000, $35,000 dollars.

DrMR: Sure.

DrJJ: So the scales of economy around these injuries, it doesn’t even make sense to not investigate and to rehab your shoulders with these, like I said, very noninvasive measures. When, in fact, prolonged therapy, and are not being willing to look at it, you’re almost guaranteeing at some point and time. If you are a person who wants to be active and continue to be active on that shoulder that does have fraying, that you are going to be getting that surgical intervention.

DrMR: Now, you say rehab. And we’ve both said rehab. And maybe something that people may be asking themselves, “Well, I saw a PT. And I had some ‘rehab.’” But there’s many different nuances, and as you described earlier, different forms of training.

So I’m sure that a PT could be trained in this, of course. But would you say that if you went to kind of a standard conventionally trained PT that this is something that you would get as part of your PT rehab plan?

DrJJ: Yes. So, again, I actually in my practice right now, I work with a lot of physical therapists. And I see a lot of nurses. Those are two of the larger groups of people that actually come in to see me. And the difference between what I would do versus what the standard, I would say out-of-the-box physical therapist would do is that I’m really an expert in phase 1 about creating emotion and mobility.

I would be able to localize the area of injury or the cause of the injury. We’re going to go in there with our hands. And we’re going to be doing a whole host of techniques to lengthen and restore tissue length. Number one, the process isn’t very comfortable. And number two, it’s very manual labor intensive. It is not easy to do this patient after patient.

So number one, a lot of practitioners don’t like to do this type of work. But more importantly, the indoctrination into an average physical therapist, they get a lot of education around movement mechanics and about how to restore movement through strength and activities, balance coordination activities. So when we think of rehab and PT, we’re thinking about an open room, lots of movement, lots of active stretching. You’re not getting intensive hands-on therapy. It’s usually a fraction of what you’re actually getting.

So in the perfect world you would do what I have to offer first. And then I would roll you into the physical therapist or the chiropractor whoever it is that actually does the active component also. In my practice, it would be both. But there are a lot of physical therapists out there who do wonderful movement reeducation or strengthening. But they don’t offer this first component.

And that’s why when people who really need this first component see them first, frequently, they don’t get the outcome that they want because the zip ties, so to speak, haven’t been released. And that may sound a little cliché, but it couldn’t be more true.

DrMR: Right. And so I came to see you just for one or two sessions, kind of me just being an idiot and beating myself up. And I believe I had pulled my left quad, I think it was. And I had said, “God, you’ve got to help me out with this quad.” And you actually ended up I believe stripping my right hamstring. And maybe this would be a good segue for you to tell people a little bit more what this looks like.

But the two things that really struck me there were exactly as you said a moment ago. I’m complaining about the pain in my left quad. And you’re finding that the reason why the quad was overtaxed was because the right hip flexor was overly contracted and not allowing proper gait and overworking the left quad. I believe that was sort of the relationship.

And you really kind of came in with your thumbs and just kind of stripped through that muscle almost like a very, very intense, targeted massage. And it hurt. It hurt. But it was kind of like that hurt that was like, “Oh, man, this hurts. But I can tell this is doing something really good in terms of kind of stripping down and breaking down all this tight tissue that has just adhesed from day after day, hour after hour of sitting in a position where the hip flexor muscle is just shortened.

Dr. Johnson’s Method

Dr. Mr: So maybe with that as a kind of a jump off point, you want to remark a little bit more about how bad I looked, if you remember anything from that? Or maybe how common that relationship is and what this kind of looks like, for someone who’s never heard of this, what this may look like for them?

DrJJ: Absolutely. So let’s go to this scenario where, as you’re talking about, whether you’re having quad pain, you’re having hamstring pain, you’re having plantar or fasciitis pain. You’re having pain down below the knee on the lateral side of the lower leg. You’re having what we still might refer to as shin splints. You might even have some deep piriformis pain on the right side.

So the very first thing we’ll do is take you through a range of motion assessment standing. And we’re going to have you bend forward and try to touch your toes. And we’re going to watch what happens when you do that very carefully.

We see a lot of different tell-tail signs about how you move normally to accomplish that, but also when certain tissues are tight how you then compensate and move in a different way. So we’re identifying compensations. And we have you bend backwards and do an extension.

And then we’re going to have you lay on your back. And what we do is, by this time we place you in a pair of our shorts and a gown if it’s appropriate for a woman. And what we’ve done is we’re going to then each individual leg, we’re going to take through six different plans of action. Your legs are going to move through six different plans of motion. We’re going to do that on both sides. And we’re going to compare and contrast.

And what we see on almost every single person that comes into the practice with a complaint of the lower body is that they almost always have shortening facilitation of their hip flexors. And the reason that happens is twofold. Number one, people sit for extended periods of time, offloading and shortening those tissues.

And the second reason is for all the younger athletes that come in, people who are a little older, it is pretty easy to go through some of the normal stretching techniques and to isolate and to stretch out the muscles that extend your hip, abduct and adduct your hip—means bringing them out to the side and bringing in—and towards a rotate internally and externally.

But it is very difficult to place your body into a position where you’re able to put end range stretch into your hip flexors. And because of that, with the combination of prolonged sitting, and also even if you are a person who says, “I stretch all the time,” it’s very difficult to get an end range stretch on those hip flexors. So over time proportionately speaking the level of stretch you’re putting into your hip flexors versus other tissues is not the same. It’s deficient. So that creates a deficiency or a shortening of those tissues in comparison to your other tissues that control your hips and your legs.

When that happens, your pelvis and your lumbar spine start to fall forward towards your hip because of the shortened hip flexors. And that creates an angulation in the femur that then causes shortening and contraction of the muscles that stabilize and control your hips.

So that could be the TFL syndrome. It can be the piriformis syndrome, glute medius, buttock pain. It can lead to a little bit of sciatica. It can cause your SI joint to be stuck. So you’re chronically getting adjusted by a chiropractor, but it kind of never goes away.

It can also create the slight turnout in your leg, and/or it can bring your weight bearings forward. And when it does that whether you have a turnout, if your foot turns out slightly to the outside, your toes, what that means is that every step and every time you flex your knees and bend down and pick something up, you are loading those tissues differently on one side of your leg versus how you would do on the other leg.

And if your weight’s being pulled forward because of tight hip flexors, you are putting more load or excessive sheer forces into your knees that are not normal, or biomechanically correct. And your body responds to those increased in loads with the shortening of tissues and inflammation.

So one simple scenario, you take the average person who sits a little too much and/or doesn’t have the opportunity to really stretch out their hips. And they’re more susceptible now to a whole bunch of different types of descriptions of tendinosis. They’re going to develop in the buttocks, in the thighs, in the hamstrings, in the lower legs, in the arch all because of the same failure pattern in the pelvis.

So we always start with first things first. And that is by identifying hip flexors and other rotational muscles of the hips. We elongate those. We stretch those. We show people at home stresses. And then what we do is we work our way down the leg.

Very rarely…And I see a lot of people that come in with plantar fasciitis. And what that is is a shortening of the fascia at the bottom of the arch. It’s very painful for people. And almost all of these people that have been to the

podiatrist have had localized cortisone injections. Well, how does cortisone in your arch correct a biomechanical deficiency that’s coming from your hip? And the answer is it doesn’t. But it’s the most commonly given intervention out there, number one.

Or a person might be given a night splint. They sleep in these boots that try to stretch out their arches or their heels, the tissues of the heels, while they’re sleeping. Very uncomfortable. It impedes sleep, not very successful. And, again, what does that have to do with balancing out a dysfunction that’s coming from the hips? And the answer is nothing.

So if you’re not able to look at these problems from a holistic standpoint and look at the whole kinetic chain, then what you’re left with is a solution that is less than optimal. And in your scenario, most of these scenarios when people come in, the correction can be made very, very quickly if you’ve identified the correct level of injury and obviously the subsequent movement dysfunctions that come as a result.

So in your scenario, I’m glad we were able to identify the tissues that were doing that for you quickly. Yes, when you have tissues that are inflamed and our pain generators, it seems like something you wouldn’t want to do to be pushing into these tissues. But the reality is this: in our society from day one we are taught to not identify the source of pain and to correct it. We are taught to medicate it and move away from it until it no longer hurts.

And so what we do in our office, instead of encouraging you to put your head in the sand and pretend that if you wait long enough and just let it rest or if you medicate it heavy enough that the pain, the chemicals will clear it and everything will be fine.

No, what we do is we help you identify the exact source of dysfunction. And then we identify all the measures that are necessary to correct it. Most of those at first are uncomfortable. But the rate with which people recover kind of compared to the traditional ways people have been taught how to address these injuries is truly amazing.

DrMR: Right. And that’s why I love your approach because it’s very similar to what I do with functional medicine, which is not getting swept up in the symptom and saying, “Well, you’re constipated. Let me give you a natural laxative, let’s say.” Well, let’s look at what the underlining cause of the constipation may be.

And also you say something that I’d like to piggyback on, which is medicating. If people are using a natural anti-inflammatory compound. I think a certain dose of that can be good because many of us are deficient in natural anti-inflammatory compounds, like omega-3s.

But if you’re someone that has to be taking, let’s say, a decent dose of curcumin and fish oil every day for months and months and months and month and then if you stop that your pain starts coming back. Yes, it is possible that you’re just feeding a nutritional deficiency there.

But I’d also offer you the food for thought, that if you can’t maintain a pain free status without being on these anti-inflammatory, these natural anti-inflammatory supports, you may want to look into something, like Dr. Johnson is recommending because you may have an underlining imbalance that’s creating extra stress or trauma in that joint. And that’s why you need this ongoing dose of anti-inflammatory compounds, even if they’re natural.

DrJJ: I couldn’t agree with you more. And that’s one of the most difficult things to do as a practitioner is to help a person identify as quickly as possible whether their pain is coming about from a functional perspective, meaning lifestyle.

Is it a lack of sleep? Is it a lack of movement and just general exercise? Is it a nutritional deficiency that’s creating this pain syndrome? And/or is there truly a structural deficiency going on, and/or both? In most people, in our lifestyles that we live today in America—very fast paced, people trying to make two ends meet—and most of us are dealing with deficiencies from both ends. And that can absolutely cloud the picture.

Episode Wrap-Up

DrMR: Right. Well, Jeff, this has been a great conversation. I think you’re on your lunch break today. So I don’t want to keep you too much longer. But is there anything you want to close with? And also where can people track you down if they wanted to read or hear more from you?

DrJJ: Well, first of all I want to thank you very much for having you on today. And I very much enjoy these conversations because it’s important for people to understand that there are larger picture, bigger holistic approaches out there that deliver much bigger results.

And the bottom line is this. If you take care of yourself by getting eight to nine hours of sleep every night, if you keep yourself hydrated, if you move your body joyously multiple time throughout the week, if you feel yourself correctly, like I’m sure they’re learning about how to do in the other segments of your programs here and you can match that with a reasonable and thoughtful approach to maintain range emotion and mobility in your shoulders and your hips, you’re going to be way ahead of your counterparts out there because those are the main things that are going to be able to drive results.

If anybody’s in the East Bay or the Bay Area in California and you’re looking for a coach like we’ve been describing here, we’d love to invite you to my practice. My practice is caused Tru Salus. That stands for True Health.

The reason we named our practice True Health is because we wanted to encourage people to have a higher call to action and to really look at all these things that we’re talking about today. And, again, my Web site is just www.TruSalus.com. And we’d love to take care of anybody here in the East Bay who’s looking for a chiropractor.

DrMR: Awesome. Well, Jeff, thanks again so much for coming on. And until the next time, my friend, keep doing your good work. And I’m sure I’ll see you around town.

DrJJ: All right. Thanks a lot, Mike. I appreciate it.

DrMR: All right, you’re welcome.

If you need help treating your chronic pain, click here.

What do you think? I would like to hear your thoughts or experience with this.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

36 thoughts on “Treating the Root Cause of Chronic Pain and Dysfunction with Dr. Jeff Johnson- Episode 59

  1. I love the fast facts! But could work around them if they are time consuming and become unavailable.

    I also love the outline on the podcasts. Podcasts are time consuming, so it’s helpful to know what sections apply and/or where to jump in at to save time.

    Thanks for all your helpful information.

  2. I could live without the fast facts. I know you are busy and could spend your time on other things. Since you already include the podcast transcript, it’s pretty easy to go back and look something up. Thanks for always providing such valuable information!

  3. I could live without the fast facts. I know you are busy and could spend your time on other things. Since you already include the podcast transcript, it’s pretty easy to go back and look something up. Thanks for always providing such valuable information!

  4. I frequently fast forward through the fast facts if I plan to listen to the whole episode. I only listen to them if I am not interested in the topic but think it would be worth at least a review/info. I found a few times that I ended up listening to the entire episode if I listened to the fast facts.

  5. Once a week, quality over quantity facts would be more than enough.
    I do not believe in overload of information, especially when it means more time spend in front of the computer, which is pretty much counter productive to what the teachings are for. Let’s stick to facts as much as possible with legitimate links offered, if somebody wants to study up more about any given subject.
    More is not better and I believe less is more……..more time to breathe and just be 🙂

    Thank you!

  6. Once a week, quality over quantity facts would be more than enough.
    I do not believe in overload of information, especially when it means more time spend in front of the computer, which is pretty much counter productive to what the teachings are for. Let’s stick to facts as much as possible with legitimate links offered, if somebody wants to study up more about any given subject.
    More is not better and I believe less is more……..more time to breathe and just be 🙂

    Thank you!

  7. Hi Dr. Ruscio,

    Thanks for another great show. I personally skip over the fast facts; I enjoy listening through the entirety of each episode, and the fast facts are kind of like “spoilers” to me. If anything, I’d rather have them at the end of the episode or maybe they could just be posted in very brief / point form with the show notes. This also might drive more traffic to your website! Just my two cents.

  8. Since you are so generous with your time already in giving us free podcasts every week, I think the fast facts could be left out (I usually skip over them anyway). Thanks again for everything you do to help us become a healthier more educated society!

  9. Question: Is the type of chiropractic care you were talking about called something or is it just one person’s experience over another? for example functional medicine vs conventional medicine. I would like to know how to identify a good chiropractor.

    Also, I like the fast facts but could live without them

    1. Hi Kristy,
      Yes, we detailed what this is called in the episode. It has a few names NMR and ART. Dr. Johnson elaborated on this in the episode and how to find someone who does this 🙂 Thanks for your feedback!

  10. Since you are so generous with your time already in giving us free podcasts every week, I think the fast facts could be left out (I usually skip over them anyway). Thanks again for everything you do to help us become a healthier more educated society!

    1. Good point Rebecca. I would place mold/mycotoxins after this if we were to order them in order of importance. They both can be important but having an ordering system helps prevent excessive testing right out of the gate. Of course someones history could effect this order also; if someone has a strong history of high level mold exposure they may want to start with a mold/mycoT eval. Just some thoughts 😉

      1. It seems that causality could flow either way here. I’m experiencing bio toxin exposure illness (endogenous and exogenous) leading to profound fatigue, and consequent lack of movement and mobility. A result is severe Fribromyalgia.which it sounds like this approach would be very helpful for.
        The root cause may lie in the toxicity, so clearing gut issues like SIBO is important for endotoxicity, and removal of exposure to mold etc. is important to address exotoxins in a hierarchical approach. But can these therapies be successful without also addressing the musculoskeletal tissues at the same time in order to improve the intracellular terrain, circulation, and drainage, required to mobilize and remove, and excrete the toxins? To what degree is good tissue condition required to support the healing process?
        In the mathematics of graph theory there are descriptive terms for the ways that sets of things (like diagnostics and therapies) are ordered. A strict linear sequence of things is said to be “totally ordered”. A hierarchical approach as you’ve described could be said to be “partially ordered”; where some subset of steps could reasonable follow each other in any order at some level,of the hierarchy on some branch of the treatment plan.
        In Some cases there are two factors that mutually re-enforce each other: For example musculoskelatal issues caused by pain and spasm secondary to dysbiosis/SIBO/Lyme/mold etc., and musculoskelatal issues / Fibromyalgia etc. leading to biotoxin illnesses through inactivity, spending time recuperating in moldy environments, lack of circulation, changes in epigenetic regulation, reduced immunity etc. In this “chicken and egg” scenario addressing one thing at a time can be like playing whack-a-mole. So sometimes there is an advantage in choosing not to rank things in a total ordering, and opt instead for a partial ordering when the things are of equivalent importance and potentially mutually causal.
        Perhaps exotoxins from mold exposure and endootoxins from internal infections form one such pair, that are peers in the treatment hierarchy, and must be addressed concurrently.

  11. Hi.
    Please consider testing the patients for Toxic Mold and Mycotoxins. One symptom is chronic muscle pain and can include joint pain too. And many many more symptoms.
    Bek

    1. Good point Rebecca. I would place mold/mycotoxins after this if we were to order them in order of importance. They both can be important but having an ordering system helps prevent excessive testing right out of the gate. Of course someones history could effect this order also; if someone has a strong history of high level mold exposure they may want to start with a mold/mycoT eval. Just some thoughts 😉

      1. It seems that causality could flow either way here. I’m experiencing bio toxin exposure illness (endogenous and exogenous) leading to profound fatigue, and consequent lack of movement and mobility. A result is severe Fribromyalgia.which it sounds like this approach would be very helpful for.
        The root cause may lie in the toxicity, so clearing gut issues like SIBO is important for endotoxicity, and removal of exposure to mold etc. is important to address exotoxins in a hierarchical approach. But can these therapies be successful without also addressing the musculoskeletal tissues at the same time in order to improve the intracellular terrain, circulation, and drainage, required to mobilize and remove, and excrete the toxins? To what degree is good tissue condition required to support the healing process?
        In the mathematics of graph theory there are descriptive terms for the ways that sets of things (like diagnostics and therapies) are ordered. A strict linear sequence of things is said to be “totally ordered”. A hierarchical approach as you’ve described could be said to be “partially ordered”; where some subset of steps could reasonable follow each other in any order at some level,of the hierarchy on some branch of the treatment plan.
        In Some cases there are two factors that mutually re-enforce each other: For example musculoskelatal issues caused by pain and spasm secondary to dysbiosis/SIBO/Lyme/mold etc., and musculoskelatal issues / Fibromyalgia etc. leading to biotoxin illnesses through inactivity, spending time recuperating in moldy environments, lack of circulation, changes in epigenetic regulation, reduced immunity etc. In this “chicken and egg” scenario addressing one thing at a time can be like playing whack-a-mole. So sometimes there is an advantage in choosing not to rank things in a total ordering, and opt instead for a partial ordering when the things are of equivalent importance and potentially mutually causal.
        Perhaps exotoxins from mold exposure and endootoxins from internal infections form one such pair, that are peers in the treatment hierarchy, and must be addressed concurrently.

  12. I love the fast facts! But could work around them if they are time consuming and become unavailable.

    I also love the outline on the podcasts. Podcasts are time consuming, so it’s helpful to know what sections apply and/or where to jump in at to save time.

    Thanks for all your helpful information.

  13. I frequently fast forward through the fast facts if I plan to listen to the whole episode. I only listen to them if I am not interested in the topic but think it would be worth at least a review/info. I found a few times that I ended up listening to the entire episode if I listened to the fast facts.

  14. Question: Is the type of chiropractic care you were talking about called something or is it just one person’s experience over another? for example functional medicine vs conventional medicine. I would like to know how to identify a good chiropractor.

    Also, I like the fast facts but could live without them

    1. Hi Kristy,
      Yes, we detailed what this is called in the episode. It has a few names NMR and ART. Dr. Johnson elaborated on this in the episode and how to find someone who does this 🙂 Thanks for your feedback!

  15. Hi Dr. Ruscio,

    Thanks for another great show. I personally skip over the fast facts; I enjoy listening through the entirety of each episode, and the fast facts are kind of like “spoilers” to me. If anything, I’d rather have them at the end of the episode or maybe they could just be posted in very brief / point form with the show notes. This also might drive more traffic to your website! Just my two cents.

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