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Freedom from Chronic Pain - a conversation with Dr. Mitchell Yass
9 Plays3 days ago
Dr Mitchell Yass created the Yass Method an alternative model of treatment for chronic pain.
The focus of the Yass Method is diagnosing and treating the cause of pain based on interpreting patients' symptoms, rather than relying on diagnostic tests.
Dr. Yass believes that many cases of chronic pain that are attributed to structural problems are actually caused by muscular weakness or imbalance.
In this episode of the Abeceder podcast Fit For My Age Mitchell explains to host Michael Millward What chronic pain is, why so many people are suffering with chronic pain and what can be done to eliminate chronic pain.
This is a hard-hitting episode that will leave any listener equipped to look again at why they have chronic pain and what they might do to achieve freedom from chronic pain.
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Transcript
Introduction to Podcast and Host
00:00:05
Speaker
on zencastr Hello and welcome to Fit For My Age, the health and well-being podcast from Abysida. I am your host, Michael Millward, the Managing Director of
Zencastr and Podcasting Benefits
00:00:18
Speaker
Abysida.
00:00:18
Speaker
ahida As the jingle at the start of this podcast says, Fit for My Age is made on Zencaster. Zencaster is the all-in-one podcasting platform on which you can make your podcast in one place and then distribute it to the major platforms like Spotify, Apple, Amazon, and Google, YouTube Music, all of them.
00:00:42
Speaker
It really does make making podcasts so easy. If you would like to try podcasting using zencastr visit Zencaster, forward slash pricing and use my author code, Abyseder.
00:00:57
Speaker
All the details are in the description. Now that I have told you how wonderful Zencaster is for making podcasts, we should make one. one that will be well worth listening to, liking, downloading and subscribing to.
Purpose of the Podcast
00:01:14
Speaker
Very importantly on Fit For My Age, we don't tell you what to think, but we do hope to make you think.
Guest Introduction: Dr. Mitchell Yass
00:01:22
Speaker
Today, my guest, who I met on matchmaker.fm is Mitchell Yass.
00:01:28
Speaker
Did I say that correctly? Close enough, absolutely. Mitchell Vass. Dr. Vass is the leading authority on diagnosing and treating chronic pain.
00:01:39
Speaker
He has written three books and created a PBS public broadcasting system special about the treatment of pain. And now he is a guest on Fit for My Age.
Exploring Jacksonville, Florida
00:01:51
Speaker
It's always onwards and upwards. Hello, Mitchell. How are you doing today? I'm great, Mike. Thanks for having me on the show. It's brilliant. It's great that you're here.
00:02:03
Speaker
Mitchell is based in Jacksonville in Florida, USA. I have not been there. I was expecting Jacksonville to be in somewhere like Mississippi. But not only is Jacksonville in Florida, it is also the city with the largest population of any city in Florida.
00:02:21
Speaker
And I bet you've never heard of it. Yeah, most people think of Florida, they think of Miami or ah Orlando, things like that. But this is ah in the northeast corner, maybe like 30 minutes south of the Georgia-Florida border.
00:02:39
Speaker
It is now the 11th largest city in the United States, roughly a million people. It's a city that's growing quickly and lots of people from the United States are coming here.
00:02:49
Speaker
for the weather and just the booming economy. So it's a great place to live. Great. Now, when you talk about the weather at the moment, it is just over 60 degrees Fahrenheit here in Yorkshire.
00:03:01
Speaker
I bet you it's somewhat hotter in Jacksonville at the moment. Yeah, so we we've reached the point where you start to get towards the hurricane season. So this is where you're getting into the 90 degree weather and with 90% humidity and it's common to have pop up thunderstorms and um in the afternoon and.
00:03:22
Speaker
So, you know, the great news is that there's air conditioning in your office, air conditioning in your house, air conditioning in your car. So, you know, when you don't want to have to deal with that that high temperature and humidity, you have ah you can get out of it. But if you want to be in it, get a little sun, be in a pool, you have access to that as well. So it's ah it's a nice time of year here. Great. Great.
00:03:43
Speaker
Now. Now that you've heard of Jacksonville, you may want to visit, and Mitchell has given us a ah good description of it, what it's like now. But the best way to arrange your travel is to do like I do and book your flights, hotels, or holidays at the Ultimate Travel Club, because the Ultimate Travel Club gives you trade prices on all sorts of travel purchases.
00:04:03
Speaker
You will find a link and a membership discount code in the description. Now, Mitchell, enough about that. Let's talk about chronic pain.
Mitchell's Journey from Construction to Physical Therapy
00:04:13
Speaker
Please could we start by you just giving us a little bit of a potted history about your career and how you came to specialize in chronic pain.
00:04:23
Speaker
Sure, so um I actually was 30 years old. I had actually been a project manager in construction, was my first career, and found that not very satisfying. After doing it for five years, I took a job in the gym And I yeah was just picking up weights because I had just found weightlifting and fell in love with it. And a guy mentioned that you could make a living treating people's bodies without reaching the point of becoming a physician.
00:04:51
Speaker
And he mentioned physical therapy. So I looked into it. I needed some prerequisites to be completed before I applied for school. I took care of that. I got into school.
00:05:01
Speaker
And one of the things that kind of makes me a bit unique is as a child, I saw my father's intelligence as something that was very beneficial. And he taught me ah the ability to create theory or do analytical ah thinking.
00:05:18
Speaker
And that allows you to determine when the information is fact or not fact. And so I came into school in a very unique position, 30 years old, with this tremendous background in understanding logic.
00:05:31
Speaker
And I was able to establish quite quickly that the curriculum being taught in physical therapy school was somewhat baseless. ah There was really no logic behind it, even though that's how people were treated.
00:05:43
Speaker
I determined that I would establish, I would get my degree, and then upon completing school, I would figure out how I wanted to treat.
Muscular Causes of Pain and Treatment Methods
00:05:52
Speaker
Probably the most pivotal thing that happened to me was I was in my last semester. Now you're going to treat people as a student.
00:06:00
Speaker
And I felt compelled to ask people if they could point to where their pain was. And when they pointed to where their pain was, it wasn't where the pain should be if the diagnosed MRI found herniated disc or arthritis or a meniscal tear or a labral tear or a compression fracture was to cause pain.
00:06:23
Speaker
So if they're not having pain where that structural abnormality should cause pain, if it was in distress, well, then by definition, it couldn't be the cause of their pain.
00:06:34
Speaker
So the only thing I had going for me was knowing that symptoms are real in real time. And so my best bet to understand what tissue was in distress creating that symptom was to interpret their symptoms.
00:06:47
Speaker
And I started doing this and started recognizing in almost every case, the cause of pain was muscular. Specifically, the thing that made that most clear was they would say that my pain was brought on by walking, climbing stairs, kneeling, reaching, bending.
00:07:04
Speaker
They always associated their pain being increased with activity and diminishing with rest. So that certainly sounded like muscle. And the four years prior to getting into school, I had taught myself the physics of weightlifting, which allowed me personally to put 40 pounds of muscle on, but really allowed me to hone in on how to isolate individual muscles.
00:07:26
Speaker
So once I saw the cause was muscular, I decided to use that methodology as a way of treating people. And I could see I could get people out of pain in a session or two. And it just kept happening. So pretty much at the point of graduating physical therapy school and entering the career, I had developed an understanding that in most cases, the cause of pain was muscular.
00:07:48
Speaker
And with this isolated strength training, I could resolve pain and then in a treatment or
Chronic Pain and Modern Lifestyle Changes
00:07:53
Speaker
two. And that became the basis of my method that I've employed for 30 years now. It's fascinating, really, that chronic pain, pain affects so many people, doesn't it? The numbers of people who will go to a medical practitioner complaining of pain is quite exceptional.
00:08:14
Speaker
Right, so ah the numbers are that there's roughly 140 million Americans and roughly 1 billion people worldwide suffering from chronic pain. Now, my point to the existing global system is that you have to at least be able to explain to people, well, where did chronic pain come from?
00:08:33
Speaker
If you can't explain where it came from, how could you explain that you know how to resolve it, right? That would be logical. So you have to go back and understand when this began, and it began in the mid to late nineteen eighty s So why did chronic pain begin in the mid to late to 1980s? And the answer is the advancement of technology, automation, phones, ah computers, all of this type of stuff. And what you would see is that in the mid to nineteen late 1980s, where prior to that, 99% of the population performed manual, multidirectional jobs and activity,
00:09:09
Speaker
We went to a point where most jobs, the majority ah for all ages was performed sitting and even activities of recreational activities became more with sitting.
00:09:21
Speaker
So what happened was people stopped using muscle. And when you stop using muscle, you begin to weaken the muscle so that when you do try to do activity, the muscles have a susceptibility towards straining.
00:09:34
Speaker
And this includes the muscles that support your head, your back, when you're using your knee, your hip, it doesn't matter where. So what you saw was this massive influx, millions of people now suffering from pain where chronic pain used to be an older individual's problem. Now people down to the age of 20 are suffering with pain.
00:09:58
Speaker
So how did it go from acute to chronic? The answer is that one of those technologies developed in the medical area was the um MRI, originally designed to find tumors in the brain.
00:10:13
Speaker
Somehow, I guess they didn't find there was enough demand for that, and they get a secondary usage saying that it can identify the cause of pain. So you have this massive influx of people who are now having acute pain.
00:10:28
Speaker
They get an um MRI, which finds one of those structural abnormalities, which are simply independent to the cause. They're not the tissue in distress. They just exist. And yet they're treated for that, never addressing the muscular cause of their pain.
00:10:43
Speaker
This leads them to sustain the muscular deficit in their ability to form their activity, which is why it went from acute to chronic.
Sedentary Lifestyles and Pain Management
00:10:52
Speaker
And that is the basis by which chronic pain evolved globally. So it's a lifestyle issue.
00:10:59
Speaker
Correct. 100% no questions asked. It's not something that happens as a result of a particular activity. It is something because our lifestyle in the Western world, the developed world, has changed.
00:11:12
Speaker
I'm reminded of what one of our MPs, members of parliament said in their maiden speech years ago. ah the first time they spoke in parliament was that they now have the sort of job that every working class parent aspires for the for their children to have.
00:11:30
Speaker
They get to sit down all day inside. And yet that aspiration is actually what could, not in everybody's case, obviously, but that sitting down all day inside is what can make an existing pain worse and turn it from acute into chronic because we don't have enough movement in our lives.
00:11:55
Speaker
Well, i I would put it to this way. So first off, let's be clear. If you go down to Africa and you look at some tribe in in the Sahara, I assure you there's no such thing as chronic pain.
00:12:07
Speaker
They don't have chronic pain because they don't have technology. So they're running around. They're getting their food. They're building their houses. They're doing all the stuff that everybody on the planet did prior to the mid to late nineteen eighty s So you could clearly see there is no chronic pain in less developed countries or areas, regions.
00:12:24
Speaker
Okay, so that's the first thing. Secondly, it is not to say that there is a direct relationship of of sedentary lifestyle to pain.
00:12:36
Speaker
Not everybody that sits has pain. It is a relationship of the force outputs of the muscles required to do activity.
00:12:49
Speaker
Versus the force requirement of activity. So if you happen to not do very much, that does mean that you don't need a lot of strength.
00:13:01
Speaker
So if you keep your level of activity very low, the high probability is you may not ever have pain, even though you do very little. But if you then choose to do something, maybe you decide you want to go skiing or you pick up swimming or you decide you want to walk a certain distance and your body is not ready for that, that that force requirement is so much greater than what your muscles are prepared to handle, then you will have pain.
00:13:27
Speaker
Conversely, you could have the highest level athlete performing the highest level activity and that person never has pain because they have developed such a level of strength in their muscles that that they can take that higher level of activity and the force requirement is less than the force output of their muscles. So they can that without symptoms.
00:13:47
Speaker
so they can do that without symptoms So a person is not should never look at somebody else and say, wow, how come they do more than me? Or how come they do less than me and they don't have pain? Well, I have pain.
00:14:01
Speaker
The answer is because you can only look within that individual's relationship of the force requirements of their activities to the force output of their muscles trying to perform those activities.
00:14:14
Speaker
And it's a very simple relationship. If force output of your muscle is less than the force requirement of yourynth of your of your activities, you have symptoms.
00:14:25
Speaker
End of story. If the force output of your muscles is greater than the force requirement of your activities, you have no symptoms. What is the the significant thing that determines that? It's your strength, how much strength you sustain.
00:14:40
Speaker
And guess what? That's within your control. So that's a wonderful thing to know. It is, and it means, I suppose, when when I hear people saying that, well, experts saying that one of the great things to do as you get older is to do weight training because that strengthens the muscles which strengthen the bone, and that will help stave off all sorts of pain-related conditions as you get older.
00:15:07
Speaker
But it seems that what you're saying is that as we leave education and part of our education is there is fit physical activity, what we should almost be doing is planning in the way in which we live as adults opportunities that enable us to have more movement and more strength building, strength maintenance type activities.
00:15:33
Speaker
it's it's It's irrefutable. I tell everybody you got a choice. If you want to be an IT person and sit at a computer for 10 hours a day, then you better plan on doing strength training if you ever plan on doing any activity and think you're not going to you know you're going to be able to do it without pain.
00:15:51
Speaker
You either do that or go back and be a plumber or a farmer. That's your two choices. Either do a job that has continuous weight-bearing, multi-directional activity, and your muscles will adapt to that. And as long as you don't do anything greatly outside the force requirement of that job, you're never going to have pain.
00:16:13
Speaker
You might have an ache or two, but you're not going to have sustained chronic pain. Or do some computer-based program type of activity, and you're going to have to strength train if you plan on doing other activities outside of that.
00:16:28
Speaker
That's your two choices. Pick one and just follow through with it. Develop a program. Make it a lifestyle. I try to get people to understand they should see weightlifting, like eating properly, showering, brushing your teeth. It's got to become a ah lifestyle aspect.
00:16:44
Speaker
I get that. I think that's really interesting that like it isn't a hobby as such. We should plan this type of physical activity into our lifestyle in the same way as we eat healthily, we sleep healthily, we do all sorts of various different things. It's about making the decision to be healthy,
00:17:08
Speaker
Well, it's about being proactive, isn't it? It's been about being proactive around the management of your health. We all start off at a point and we have, like you say, the decisions to make. if we Our career will impact our level of health.
00:17:23
Speaker
If you choose one career, you may end up with particular types of conditions. If you choose another one, you'll end up with other types of conditions. that's There's a balance to be made somewhere.
00:17:35
Speaker
But the the simplest way to look at it is like, as human beings, we are designed to work in a particular way. If we don't behave in that way, then we have to take some sort of compensationary actions, lifestyle decisions, in order to make sure that our body is not adversely affected by our lifestyle choices.
00:17:58
Speaker
Yeah.
Chronic Pain as a Lifestyle Disease
00:17:59
Speaker
so i'll give you I'll give you kind of an example. So chronic pain has still not been accepted, as you described, a lifestyle-related issue.
00:18:09
Speaker
But type 2 diabetes, cardiovascular disease, and obesity have. And so there is this Discovery Channel documentary about these people called the Cliff Runners. And it takes place in some southwestern kind of ah state in the United States.
00:18:24
Speaker
It's this kind of indigenous Indian type of tribe people. And they lived on a plateau ah that was near a cliff. And they followed all the basic. They would hunt and they would build their homes and the very physical type of lifestyle, very low level of technology.
00:18:44
Speaker
And all of a sudden in the... The area below the cliff, people came and they built towns and cities and technology came. A percentage of the cliff runners actually went down.
00:18:58
Speaker
and entered that type of environment. And what they found, and it's remarkable, all these people who ah above the cliff were healthy and had great types of lifestyles and stuff, all the ones that went down to where technology was ended up being excessively overweight with diabetes, cardiovascular disease.
00:19:22
Speaker
yeah So they all had the same genetics. They all came from the same group. But what changed was environment changed. And basically, when they got to this lifestyle of sitting and not exercising or being physically active, all those environmental types of diseases developed in them.
00:19:43
Speaker
And it kind of reinforced the point that cardiovascular disease, ah type 2 diabetes and obesity are actually lifestyle diseases. I'm just trying to get everybody to recognize that chronic pain is, in fact, the
Movement and Job Design to Prevent Pain
00:19:58
Speaker
same.
00:19:58
Speaker
A left ah lifestyle issue. Yes. With my HR professionals hat on. I am starting to think that chronic pain is almost like a job design issue as well.
00:20:11
Speaker
Somebody can have yeah the right type of lifestyle. When I'm thinking about designing a job, I should be thinking about designing it in a way which involves movement, which involves people having to use muscles so that they don't actually run the risk of developing chronic pain.
00:20:30
Speaker
Yeah, I would agree 100%. So if you accept the idea, and this is my preposition, I know very few people are going to accept this, but I'm telling you now that more than 98% to 99% of cases of chronic pain, the cause it's muscular.
00:20:46
Speaker
Right. So muscles basically end up eliciting pain, either because the force requirement of an activity you try to perform is greater than the force output of that muscle. The muscle is just not strong enough.
00:20:57
Speaker
But another possibility is that you sustain an excessive stretching of a muscle in a way that the muscle can't handle that. And it rebounds and strains in that regard.
00:21:08
Speaker
So if we accept that the cause of pain in most cases is muscle, as you described, if you're going to do a job, right? If you recognize that that person is going to be sitting for a while, you have to understand that the hip flexor muscle, the psoas muscle, which attaches from the back to the hip, shortens half its distance in the sitting position.
00:21:32
Speaker
So that muscle will shorten if that person sits for an hour, two hours, three, four or five hours. So we would want to say to ou ourselves, number one, if we do require that person in that job to sit, well, why don't we set them in a chair?
00:21:48
Speaker
where the hip is actually three to four inches higher than the knee, so their thigh is pointing down slightly, and their shoulder is two to three inches behind the hip.
00:22:01
Speaker
So when having that sitting position, we have just severely opened the angle between the torso and the thigh, thereby impeding how short that hip flexor has to be in that sitting position, limiting the chance of it shortening and straining when you suddenly have to stand up again.
00:22:21
Speaker
So if you designed the position of sitting, you could offset a lot of the negative effects of sitting. Combine that with that person strengthening their gluteus maximus muscle, their butt muscle, which is the opposing muscle to the psoas muscle.
00:22:40
Speaker
Between those two things, that probably will prevent that person from ending up having lower back pain from a job where they have to sit for long periods of time.
00:22:50
Speaker
Because the chair is a fairly basic design. It has a number of legs, a seat that you sit on that is always flat, and some form of back support. And it's almost like the same design is used in, well, the same design is used for all sorts of activities, regardless of the length of time that that activity will take place.
00:23:13
Speaker
So if you're sitting down for a meal, you'll sit in a chair for half an hour. You sit in a car, you might be driving that car for an hour, an hour and a half.
00:23:24
Speaker
You sit down at work, you are sitting there for eight hours perhaps, maybe be even longer. We're using the same design of equipment, but what you're saying is that it's important to design the tools that we use for the purpose of the job and understanding how the muscles work should influence the design of the the tools that we use.
Ergonomics in Everyday Life
00:23:55
Speaker
Well, like for instance, I mean, you know you do have these computer chairs now and that computer chair has the ability of the seat to go up and down and it has the ability of the backrest to go back on an angle.
00:24:08
Speaker
So what I'm saying is that there is that possibility for that chair to be to be raised so that when you're sitting, your knee is pointing down slightly, say two inches below the hip And you could set that chair back in a way that your shoulder is two inches behind your your um hip.
00:24:30
Speaker
And as a result, where the typical person believes, and this is this is a lot of cultural problems, is that the person believes and has been taught you should sit up straight. That's completely wrong.
00:24:41
Speaker
Completely wrong. Sitting at a 90 degree angle is very bad. And for the person who has a couch... Oftentimes that couch has your knee higher than your hip.
00:24:52
Speaker
You have made the angle between the thigh and the torso even more acute. So by understanding that you want to, so instead of sitting at 90 degrees, sitting at an angle where you have say 120
00:25:06
Speaker
angle between the the thig the torso and the thigh will make a massive difference in how the psoas muscle responds to that sitting.
00:25:17
Speaker
So that knowledge can allow you to use that same tool. And even in the car, the seats have the ability adjust. So I agree with you 100% that the seat has been the seat has been the seat.
00:25:29
Speaker
But now there are options with the understanding of how to use the seat. to make it such that the seed is no longer such a detrimental thing to have to use during your day. does require quite a rethink of something which many people will think is as basic as a chair.
00:25:49
Speaker
We really need to think again about how those sorts of things are used. I know that one of the things that we could do today is we could move printers away from people's desks.
00:26:02
Speaker
So if you want to print something, you actually have to get up and walk to somewhere to actually go and collect your printing. and simple straightforward little things it's amazing it's know Mitchell it has been really really very interesting you've given us a huge amount of information but i've still feel as if we're just scratching the surface of what is a an issue that impacts a billion people around the world and in many organizations will impact colleagues and potentially everyone who sits and works and
00:26:37
Speaker
Nowadays, of course, sitting to work doesn't necessarily mean that you're in an office. You can be sitting and working because you're in high-tech manufacturing or very detailed manufacturing as well.
Podcast Conclusion and Resources
00:26:48
Speaker
So really great.
00:26:50
Speaker
Really appreciate it. Great insight. Thank you very much. i really appreciate your time. Thanks for having me, and and thanks for giving me the chance to give people that understanding that um they don't have to live in chronic pain, that in most cases it's not structural, it's muscular, which means they have the capacity to address it, resolve it, and live the life that they have every right to.
00:27:11
Speaker
Great. Brilliant. I am Michael Millward, the Managing Director of Abucida. And in this episode of Fit for My Age, I have been having a conversation with Dr. Mitchell Yas, a specialist in the treatment of chronic pain.
00:27:26
Speaker
You can find out more about both of us at abucida.co.uk. There is a link in the description. I must remember to thank the team at matchmaker.fm for introducing me to Mitchell.
00:27:38
Speaker
If you are a podcaster looking for interesting guests, or if like Mitchell, you have something very interesting to say, matchmaker.fm is where matches of great hosts and great guests are made.
00:27:51
Speaker
There's a link to matchmaker.fm and an offer code in the description. At Fit for My Age, our aim is proactive positive aging. Knowing the risks early is an important part of maintaining good health.
00:28:04
Speaker
That is why we recommend the annual health test from York Test. York Test provides an assessment of 39 different health markers, including cholesterol, diabetes, vitamin D, vitamin B12, liver function, iron deficiency, inflammation, and a full blood count.
00:28:20
Speaker
The annual health test is conducted by an experienced phlebotomist who will complete a full blood draw at your home or workplace. ah speaker Hospital standard tests are carried out in a UKAS accredited and CQC compliant laboratory.
00:28:37
Speaker
You can access your easy to understand results and guidance to help you make effective lifestyle changes anytime via your secure Personal Wellness Hub account. There is again a link and discount code in the description.
00:28:50
Speaker
That description is well worth reading because it will also include links to all of the books that Mitchell has written and his website and the PBS special that he created as well.
00:29:02
Speaker
If you have liked this episode of Fit for My Age, please give it a like and download it so that you can listen anytime, anywhere. To make sure you don't miss out on future episodes, please subscribe. Till the next episode of Fit for My Age, thank you for listening and goodbye.