Latest / hol+ with Dr. Taz MD | The Future of Medicine is Holistic / The No. 1 Contributor to Chronic Pain & Why it's NOT Just a Result of Aging with Dr. Dan Ginader
Transcript
- [00:00:00] Dr. Dan Ginader, DPT: One of the things that can reduce pain at a chronic level the most reliably [00:00:05] is just optimism. Uh, when I tell people that [00:00:10] optimism can really make a radical difference in their pain, I generally gets a chuckle or it [00:00:15] gets a lack. Right? Yeah. 'cause it sounds kind of, [00:00:16] Dr. Taz: I was like, come on, [00:00:17] Dr. Dan Ginader, DPT: it, it sounds kind of silly. [00:00:19] Dr. Dan Ginader, DPT: But [00:00:20] they have looked at the mindset in people dealing with chronic pain and the people with a more [00:00:25] positive mindset. Even if all the other factors, all the other cobi comorbidities are [00:00:30] equal, the people with a positive mindset will have fewer reports of pain, and that [00:00:35] pain when it does come on will be less intense. [00:00:37] Dr. Taz: How many of us have woken up on a given morning [00:00:40] with a few aches and pains and have quickly said, oh my gosh, I'm [00:00:45] finally getting old. Well, we wanna change that dialogue and that narrative, and that's why [00:00:50] we invited our next guest onto the show. Dr. Dan is a Doctor of Physical [00:00:55] Therapy, author of the Pain-Free Body and Clinic Director at Mims [00:01:00] Method Physical Therapy in Midtown Manhattan. [00:01:02] Dr. Dan Ginader, DPT: A 90-year-old person [00:01:04] Dr. Taz: yeah, [00:01:05] [00:01:05] Dr. Dan Ginader, DPT: that looks, that has good posture and they look strong. I guarantee you, they're [00:01:10] not sitting for longer than 30 to 45 minutes. Number one contributor to chronic pain is [00:01:15] sedentary behavior. [00:01:16] Dr. Taz: Really? Yes. Okay. We've gotta hold that for a second. Okay. The number one [00:01:20] contributor to chronic pain is being sedentary. [00:01:23] Dr. Taz: Yes. Or sedentary [00:01:25] behavior. Why? [00:01:25] Dr. Dan Ginader, DPT: Well, it leads to a lot of tightness. It leads to a lot of atrophy. It leads to a [00:01:30] lot of weakness. People that are more sedentary are more likely to suffer from depression. People that suffer from [00:01:35] depression are more likely to suffer from chronic pain. The act of moving very little.[00:01:40] [00:01:40] Dr. Dan Ginader, DPT: Has a lot to do in terms of contributing to the overall [00:01:45] complex of feeling pain, and so sedentary behavior is a really good way [00:01:50] to just describe a lot of different factors when it comes to things that can contribute to to chronic pain. [00:01:54] Dr. Taz: [00:01:55] He specializes in sports, physical therapy, working with professional dancers [00:02:00] and Broadway performers, and treats with a full body approach rooted in [00:02:05] education and long-term resilience. [00:02:07] Dr. Taz: Dr. Dan is passionate about helping people [00:02:10] understand why pain develops, why many aches are preventable, and what it takes to [00:02:15] stay active and independent as we age. Please join me in welcoming Dr. [00:02:20] Dan to the show. This episode is sponsored by Whole Plus, a holistic health platform [00:02:25] built around education. [00:02:26] Dr. Taz: Personalization and integrative care. Whole plus [00:02:30] blends holistic, integrative and functional medicine clinics with learning [00:02:35] resources like blogs, YouTube videos, and of course this podcast. So you're not just treated, [00:02:40] you're informed. The platform also includes holistic health quizzes and a curated wellness [00:02:45] shop, helping you make choices that support your body at the root level. [00:02:49] Dr. Taz: Whole [00:02:50] Plus is holistic healthcare designed for real [00:02:53] Dr. Dan Ginader, DPT: life. Visit [00:02:55] us@wholeplus.co to learn more about the platform. Again, that's HOL [00:03:00] ps.co. [00:03:01] Dr. Taz: All right. I opened the intro talking about the [00:03:05] fact that so many people I meet and I, and I'm sure the audience would resonate with this, [00:03:10] you know, we'll wake up with an ache or a pain somewhere, and their first go-to response is like, [00:03:15] oh my God, I'm getting old, or. [00:03:17] Dr. Taz: You have the weekend warrior and they're out there doing [00:03:20] pickleball or training for that marathon, and boom, they rupture something, damage [00:03:25] something. I actually did that myself. I ruptured my Achilles a couple years ago. Oh no. So anyhow, [00:03:30] all of these ideas that we have around pain and the body, you know, [00:03:35] are things that you have dug deeply into and explore over and over again. [00:03:39] Dr. Taz: What do we get [00:03:40] wrong when we're talking about pain? [00:03:42] Dr. Dan Ginader, DPT: I think the main thing that people get wrong is that pain is [00:03:45] unavoidable when in reality, almost all the causes of pain, especially the cause that [00:03:50] you listed, is just somebody doing a little too much too soon. Sometimes it's somebody that thinks that [00:03:55] they can handle pickleball, but they lose track of the fact that they haven't made a quick cutting movement in about a decade. [00:03:59] Dr. Taz: Mm. [00:03:59] Dr. Dan Ginader, DPT: [00:04:00] Sometimes it's people that think that, oh, all I did was go to the grocery store and then go to Home Depot [00:04:05] and then go somewhere else. But they lose track of the fact that they've been more or less sitting down for the [00:04:10] past two weeks and they haven't run three consecutive errands back to back to back. [00:04:13] Dr. Taz: Mm. [00:04:13] Dr. Dan Ginader, DPT: And so it's all [00:04:15] relative to the scale of what you're used to. And then if you do a little too much, a little too soon, that's generally [00:04:20] where a lot of this pain can come from. [00:04:21] Dr. Taz: Interesting. What do we get wrong when we. [00:04:25] Think about pain. Is there something that we're just not understanding when it comes to the physiology and the [00:04:30] root cause of pain? [00:04:30] Dr. Taz: I think, you know, aging, everyone will blame aging. Like I mentioned, some [00:04:35] people will think that they did something physically wrong in their day-to-day activity or in a [00:04:40] sport, you know, is that the true root cause of pain? Like where is pain [00:04:45] actually coming from? [00:04:46] Dr. Dan Ginader, DPT: Well, the funny thing about pain is that there isn't ever one true cause, [00:04:50] especially when pain is chronic, meaning that pain has been around for longer than three months. [00:04:54] Dr. Dan Ginader, DPT: A lot of that [00:04:55] cause is coming from the brain or coming from your nervous system or coming from the [00:05:00] expectation of pain or your relationship with pain, and the longer pain is around the less. Of a [00:05:05] relationship, it has to actual an actual mechanical cause. Mm. So obviously if you make a quick movement, you rupture [00:05:10] your Achilles. [00:05:10] Dr. Dan Ginader, DPT: That is a one-to-one correlation. That's a mechanical cause. That's where your pain is coming from. [00:05:15] But when it comes to a back pain that is. Very prominent in today's culture in [00:05:20] today's world and millions and millions of people are dealing with it. Yeah, yeah. I've been dealing with it. I think a lot [00:05:25] of what people tend to get wrong is they lose track of just how complex that pain can [00:05:30] be and they want to blame it on age, or they wanna blame it on arthritis, or they wanna blame it on one [00:05:35] specific thing, especially something that's out of their control. [00:05:37] Dr. Taz: Mm-hmm. [00:05:37] Dr. Dan Ginader, DPT: When in reality, pain is far more complex than [00:05:40] that and there's a lot more in your, your control than, than isn't. [00:05:43] Dr. Taz: So what is the root [00:05:45] cause of pain? Then? What, where, where is if we had to dial it down, right. When I sit with patients, I'm always like, okay, [00:05:50] this is our starting point. This is, this is like ground zero, you know, of everything we're dealing with. [00:05:54] Dr. Taz: [00:05:55] You know, what is the, where's ground zero when we're talking about pain? [00:05:59] Dr. Dan Ginader, DPT: Ground [00:06:00] zero would be, I guess if you really had to pinpoint it, would just be how your brain [00:06:05] is interpreting the threat that it's getting somewhere in the body. And so that [00:06:10] is why people can have radically different pain tolerances to the same exact stimulus. [00:06:14] Dr. Dan Ginader, DPT: It's because their [00:06:15] brains are interpreting that threat as either something more threatening that deserves more of a pain [00:06:20] response or less threatening that deserves less of a threat. Uh uh. Pain response. So if you look at a [00:06:25] chef that is used to touching hot things, dealing with hot things, I've seen a chef reach in and [00:06:30] flip a chicken cutlet and [00:06:31] Dr. Taz: Oh, really? [00:06:31] Dr. Dan Ginader, DPT: Rip and ripping hot oil with their fingers? Ah, uh, sure. [00:06:35] Part of that is that they've done that enough to where they've built up calluses and sure they, they have a little bit [00:06:40] more of a resilience in their fingertips, but also their brain has learned over time by [00:06:45] doing that, that while their finger may feel a little hot, and while it may hurt in the short term, [00:06:50] they've kind of. [00:06:51] Dr. Dan Ginader, DPT: Figured out that it is not an overly threatening thing that deserves [00:06:55] a large pain response. Whereas if you take someone who has never done that before, their brain [00:07:00] is like, that's the hottest thing I've ever touched in my life. This must be harmful. We deserve a, [00:07:05] a high pain response so that we know to retract our hand, take it away. [00:07:09] Dr. Dan Ginader, DPT: And so we don't [00:07:10] do that again. And so the relationship with pain. Is far, has [00:07:15] far more to do with how much pain you feel than at the actual mechanical stimulus. [00:07:19] Dr. Taz: [00:07:20] So we had studied forever ago, and I'm blanking, uh, there was like a [00:07:25] pain pathway or pain cycle, right? That sort of, you know, perpetuated [00:07:30] itself. [00:07:30] Dr. Taz: Is that. Kind of what you're talking about, like once we experience pain, [00:07:35] then the anticipation of that pain or the fear of that pain sort of potentiates, it makes it [00:07:40] more and more and more intense each cycle around. Is that a part of this pain [00:07:45] equation? Is a lot of our emotional response to it, not just the actual [00:07:50] physical response to it. [00:07:51] Dr. Dan Ginader, DPT: 100%. Because let's say you are in pain, that pain may limit [00:07:55] your sleep. If you limit your sleep, you also kind of raise your cortisol levels. You're, you're less [00:08:00] adept to, to deal with that pain. The more you feel pain, the more you expect to feel that pain. Uh, a lot [00:08:05] of studies have been done that show just you expecting to feel pain will increase [00:08:10] your pain response. [00:08:11] Dr. Dan Ginader, DPT: And so it starts to feed into this never ending loop. [00:08:15] And that's also why, uh, one of the things that can reduce pain at a chronic level the [00:08:20] most reliably is just optimism. Uh, when I tell people [00:08:25] that optimism can really make a radical difference in their pain, it [00:08:30] generally gets a chuckle or it gets a left right? [00:08:31] Dr. Taz: Yeah. Does it sounds, everyone's like, come on, [00:08:33] Dr. Dan Ginader, DPT: it sounds kind of silly, [00:08:35] but. They have looked at the mindset in people dealing with chronic pain [00:08:40] and the people with a more positive mindset. Even if all the other factors, all the other cobi comorbidities [00:08:45] are equal, the people with a positive mindset will have fewer [00:08:50] reports of pain. [00:08:50] Dr. Dan Ginader, DPT: And that pain when it does come on will be less intense. [00:08:53] Dr. Taz: I mean, that's groundbreaking in [00:08:55] itself, right? So if we are saying optimism. Can change pain and a [00:09:00] positive mindset really does shift your perception of pain. [00:09:05] When patients come into the exam room or into your office and complaining of [00:09:10] pain, where do you start with them? [00:09:12] Dr. Taz: Do we start with the mind and emotions or We do we start [00:09:15] where the injury actually may or may not be. [00:09:18] Dr. Dan Ginader, DPT: So the place that I have [00:09:20] to start. I have to show that I'm listening to them and I have to show that I [00:09:25] understand where they are in terms of their pain. And then I try to [00:09:30] explain how that pain may have manifested, how, how that pain may have grown. [00:09:34] Dr. Dan Ginader, DPT: And then [00:09:35] I try to find one thing, even if it's small, to change the pain, because even if [00:09:40] I can only change that pain a little bit. Or even if I can only change that pain for the next hour that they leave, [00:09:45] at least I then give them the thought and I give them the hope that, oh, something can be [00:09:50] done about this. [00:09:50] Dr. Dan Ginader, DPT: It's not hopeless. Um, and then once I kind of. [00:09:55] Feed them that idea, then they're more likely to do the exercises, the [00:10:00] mobilizations, to kind of move forward. The work that [00:10:02] Dr. Taz: go. [00:10:03] Dr. Dan Ginader, DPT: Exactly. [00:10:04] Dr. Taz: So interesting, [00:10:05] I see this in practice as well, is that that message of, you know, hope, [00:10:10] right? Or like this will go away, or this can get better, you know, this is not a life sentence [00:10:15] in itself. [00:10:16] Dr. Taz: Is such a healing statement for so many people, and I think people don't [00:10:20] hear that enough from their practitioners and their teams and their providers, you know? Why do [00:10:25] you think we don't lead with that when we're managing, you know, patients [00:10:30] or issues with pain or injuries or any of these different things? [00:10:34] Dr. Dan Ginader, DPT: Well, [00:10:35] unfortunately, if it's not done correctly, I think it can come off as condescending. [00:10:38] Dr. Taz: Mm. [00:10:39] Dr. Dan Ginader, DPT: Because especially [00:10:40] somebody like myself that [00:10:41] Dr. Taz: I can see that [00:10:41] Dr. Dan Ginader, DPT: our physical therapy clinic is more expensive and [00:10:45] it's a little harder to get in. We generally have like a six week wait list. Mm-hmm. And so for the most part, we are seeing people that [00:10:50] have seen a bunch of other medical practitioners, and the thing that they're not happy with is they feel like they [00:10:55] haven't been listened to. [00:10:56] Dr. Dan Ginader, DPT: They feel like they're not taken, taken seriously, and they just feel kind of [00:11:00] scorn by the process of. Dealing with American healthcare. [00:11:03] Dr. Taz: Yeah. [00:11:03] Dr. Dan Ginader, DPT: And so [00:11:05] I always try to make sure that, that first session I really listen. I [00:11:10] really let them know that I'm here for them and I understand where they're coming from, but if I try [00:11:15] to jump to, oh, you'll be fine. [00:11:17] Dr. Taz: Right? Or, [00:11:17] Dr. Dan Ginader, DPT: oh yeah, this will get better. [00:11:19] Dr. Taz: Yeah. Or this is [00:11:20] normal. [00:11:20] Dr. Dan Ginader, DPT: Right? [00:11:20] Dr. Taz: That's another one. [00:11:21] Dr. Dan Ginader, DPT: Right. Then I'm, I'm almost discrediting their experience in a way, [00:11:25] and so. It does you, I think you really do have to build a relationship [00:11:30] first, and you do have to show that you have the tools to make that, that little change, [00:11:35] to then build in that, that trust and then, and then we can have the [00:11:40] more kind of complex talks about. [00:11:41] Dr. Dan Ginader, DPT: The, the nature of pain [00:11:44] Dr. Taz: and when does [00:11:45] pain go from, okay, I hurt myself, I told you about my Achilles. When does it go from something [00:11:50] acute to then chronic pain? Like when does that trans, when and how does [00:11:55] that transition happen? Like I, again, going back to me, it's not all about me, but I ruptured my [00:12:00] Achilles, right? [00:12:00] Dr. Taz: 2021. Horrible, you know, couldn't move. [00:12:05] Limited mobility. But I came back. Right. And I'm back to doing everything I [00:12:10] used to do. I don't run 'cause I'm, I'm scared honestly. But, but, uh, but I, I do just [00:12:15] about everything else. So I, I'm past it now. That acute pain [00:12:20] episode is not a chronic pain issue for me. Why do some people move [00:12:25] from an acute pain issue to more of a chronic pain type [00:12:30] syndrome? [00:12:30] Dr. Taz: And I see that a lot in the exam room. What do you think is happening there? [00:12:34] Dr. Dan Ginader, DPT: Well, I think [00:12:35] you mentioned it just a little bit in the rundown of that question. So the, by the book definition of a chronic pain is a pain that's [00:12:40] been around for longer than three months. So chronic pain kind of has this almost dirty [00:12:45] connotation to it. [00:12:45] Dr. Dan Ginader, DPT: But if you've been feeling a discomfort for longer than three months, we can call that chronic pain. And the [00:12:50] thing that contributes most to chronic pain in terms of what I've seen as a practicing physical therapist [00:12:55] is in the same way that you said that you were. Afraid to return to running. [00:12:58] Dr. Taz: Right, right. [00:12:58] Dr. Dan Ginader, DPT: Uh, running is a higher [00:13:00] level activity, of course, right? Like you're still capable and you're still able to do a bunch of things. But that same [00:13:05] process takes place for a lot of other people where the thing that they're returning to or afraid of [00:13:10] returning to may not be something as high level as running. [00:13:12] Dr. Dan Ginader, DPT: It may be as simple as leaving the house. It may be as [00:13:15] simple as walking around the block. Mm. And the number one contributor to chronic pain is [00:13:20] sedentary behavior. [00:13:21] Dr. Taz: Really? Yes. Okay. We've gotta hold that for a second. Okay. The number one [00:13:25] contributor to chronic pain is being sedentary. Yes. Or sedentary behavior. [00:13:29] Dr. Taz: [00:13:30] Why? [00:13:30] Dr. Dan Ginader, DPT: Well, it leads to a lot of tightness. It leads to a lot of atrophy. It leads to a lot of [00:13:35] weakness. People that are more sedentary are more likely to suffer from depression. People that suffer from [00:13:40] depression are more likely to suffer from chronic pain. The act of moving very little [00:13:45] has a lot to do in terms of contributing to the overall. [00:13:49] Dr. Dan Ginader, DPT: [00:13:50] Complex of feeling pain. And so sedentary behavior is a really good way to [00:13:55] just describe a lot of different factors when it comes to things that can contribute to, to chronic pain. [00:13:59] Dr. Taz: [00:14:00] So we used to talk about sedentary behavior only in older populations, right? Because, you know, maybe [00:14:05] they had retired or, you know, fallen into a certain pattern in their lifestyle, so they were [00:14:10] more sedentary. [00:14:11] Dr. Taz: I actually think kids today are more se sedentary than they ever used to be. [00:14:15] Teenagers, you know, people in their twenties, everyone's like on a phone or a device or a computer, [00:14:20] you know? What does that look like in terms of the injuries that you guys are seeing on a [00:14:25] day-to-day basis? You know, are you just seeing seniors or are you. [00:14:28] Dr. Taz: Seeing younger folks, are [00:14:30] you seeing, you know, this executive or sort of mid-career world where again, we're [00:14:35] just sitting at desk all, I mean, I'm right there with everyone just sitting at a desk, you know, kind of all day long and [00:14:40] then maybe thinking about movement as an afterthought or as a scheduled workout. [00:14:44] Dr. Taz: I [00:14:45] mean, kind of tell us what you're seeing happening kind of in real life in your clinics. [00:14:49] Dr. Dan Ginader, DPT: Well, I [00:14:50] was, I was practicing pre COVID. Mm-hmm. I had practiced from 2017 to [00:14:55] 2020, and. Everything that I've seen post COVID is [00:15:00] people have just become more sedentary. [00:15:03] Dr. Taz: Yeah. [00:15:03] Dr. Dan Ginader, DPT: Uh, a lot of people have gotten [00:15:05] used to working from home. [00:15:06] Dr. Dan Ginader, DPT: A lot of people have gotten used to, maybe they were really active [00:15:10] before COVID hit, and then once COVID hit because the gyms were closed or because they didn't wanna leave or because they didn't wanna [00:15:15] out, maybe they haven't ever returned to that level of exercise. Right. [00:15:20] Um, and also, like you said, a lot of the, the younger kids, they're. [00:15:23] Dr. Dan Ginader, DPT: They're not quite [00:15:25] as strong and agile as I feel like they were pre COVID. [00:15:29] Dr. Taz: Mm-hmm. [00:15:29] Dr. Dan Ginader, DPT: [00:15:30] Because of the, the culture of the iPads and the video games and things like that. And I don't think I can [00:15:35] necessarily blame them. I mean, video games are, it's the culture. Yeah. It's the culture and video games have gotten so good that [00:15:40] a. [00:15:40] Dr. Dan Ginader, DPT: Everything is available to you just with your, with your thumbs, right? And then also you, you [00:15:45] kind of don't even have the excuse of, you need to go see friends, you need to go talk to friends. They're like, well, I'm talking to my [00:15:49] Dr. Taz: friends. I am, they're [00:15:50] right here. [00:15:50] Dr. Dan Ginader, DPT: I'm talking to my friends. They're right here, right? [00:15:52] Dr. Dan Ginader, DPT: And my imaginary is running. My imagination's running wild. And so. [00:15:55] I think it's, it's both technology's gotten so good that we're sitting more, and I think [00:16:00] there was a massive shift in COVID that led to people being far less active than they were pre [00:16:05] COVID. [00:16:05] Dr. Taz: That's so concerning to me. I mean, even my own son, you know, who's highly [00:16:10] intelligent and, and works really hard. [00:16:12] Dr. Taz: I'm like having to remind him like, okay, [00:16:15] have we gotten any physical activity today? Have we moved at all today? Because he's in a season [00:16:20] right now where he doesn't have a sport. And it, it's like that dynamic activity that happens beyond [00:16:25] maybe walking the campus is negligible, you know? And so I'm just going like, this can't, this [00:16:30] can't be good. [00:16:30] Dr. Taz: And what does it mean for these kids in this generation in another [00:16:35] 20 years or in another 30 years? Are there common injuries that you're seeing over and over [00:16:40] again? [00:16:40] Dr. Dan Ginader, DPT: I think it's less about the commonality of a certain diagnosis [00:16:45] and more just I'm seeing younger people than I was ever used to. [00:16:48] Dr. Taz: Interesting. [00:16:49] Dr. Dan Ginader, DPT: When [00:16:50] I first started working, it was uncommon for me to see someone who was younger than [00:16:55] 30. It was, it was downright strange. It was nice because for the most part, it meant that they [00:17:00] were an athlete. Mm-hmm. Or it meant that they were so active that it was mostly an overuse thing. [00:17:04] Dr. Taz: Yeah. [00:17:04] Dr. Dan Ginader, DPT: [00:17:05] But now I'm seeing a lot more people. [00:17:08] Dr. Dan Ginader, DPT: In their twenties and in their young thirties [00:17:10] that are dealing with a kind of pain that I more so would've associated with just a, [00:17:15] a mid forties, early fifties corporate worker. And it's, [00:17:20] it's really, it's really kind of interesting and a little scary, just how, [00:17:25] how much activity has kind of turned down in, in today's culture. [00:17:29] Dr. Taz: [00:17:30] So if we're trying to write, you know. Pain prevention prescriptions [00:17:35] and we're doing it by age group, you know, what would you tell, you know, [00:17:40] a teenager or somebody in their early twenties, like how much should they be moving to [00:17:45] prevent chronic pain? What would you tell somebody in that midlife era? Maybe [00:17:50] 35 ish to 50. [00:17:51] Dr. Taz: And what would you tell someone kind of over 55 or so, [00:17:55] like is there, you know, if we could help. People quantify it a little bit because I think people get into [00:18:00] habits. It's just like diets, right? You get into habits and you don't realize what you're doing until someone kind of [00:18:05] shows you. So if we could help people maybe quantify like, this is the [00:18:10] minimum amount of activity that you should be doing, what would you tell them? [00:18:14] Dr. Dan Ginader, DPT: [00:18:15] I would normally start with the American Heart Association has a general [00:18:20] recommendation in terms of how much activity you need to reduce your risk of all cause mortality. And it's [00:18:25] 150 minutes a week of moderate exercise. And so you just split that up [00:18:30] between 30 minute workouts five days a week. And if you're doing that, that's a really good start. [00:18:34] Dr. Dan Ginader, DPT: Okay. And then [00:18:35] regardless of age, in those 30 minutes of activity, I encourage people to try as [00:18:40] many different things as possible. If you think that you would enjoy yoga. Try yoga. If you think that you might enjoy [00:18:45] Pilates, try Pilates. If the only thing that you wanna do is walk around the block, walk around the block, but [00:18:50] try enough things to figure out what you really connect with. [00:18:52] Dr. Dan Ginader, DPT: And the thing that you connect with may surprise you. [00:18:55] Maybe you're, maybe you take a dance class and you're like, oh, maybe I, I should be dancing more. But [00:19:00] the thing that you enjoy is the thing that you're going to end up doing. [00:19:05] Nobody is going to sustain a workout or an exercise routine if it is [00:19:10] filled with stuff that they don't enjoy. [00:19:12] Dr. Dan Ginader, DPT: And. I've yet to find [00:19:15] someone who can't find something that involves moving their body, that they don't at least [00:19:20] enjoy a little bit. And then the thing that you enjoy is the thing that I will hammer that you do, because [00:19:25] that's the most likely thing that, that you will continue to do. [00:19:27] Dr. Taz: It doesn't feel like 30 minutes a day, five [00:19:30] days a week is a tall order. [00:19:31] Dr. Taz: Are people not even moving that much? [00:19:33] Dr. Dan Ginader, DPT: So a lot of [00:19:35] people, especially now with the rise of exercise classes, [00:19:38] Dr. Taz: right? [00:19:39] Dr. Dan Ginader, DPT: They think if I [00:19:40] can get to two exercise classes a week. I'm fine. [00:19:43] Dr. Taz: Ah, [00:19:43] Dr. Dan Ginader, DPT: and then I see they're [00:19:45] working out for two hours a week, and it's split up between, you know, a Monday and a Thursday, [00:19:50] and then outside of that Monday and Thursday for one hour a pop, you're, you're sitting all [00:19:55] day working at a computer, and then you put the computer away and you sit on the couch and then you watch tv and there's [00:20:00] very little movement in the interim. [00:20:02] Dr. Dan Ginader, DPT: Mm. And it's that lack of interim [00:20:05] movement. That seems to be the issue, not just because there's so much [00:20:10] sedentary behavior in between, but also if the two main things that you're [00:20:15] doing are sitting. And then doing a really tough workout, [00:20:18] Dr. Taz: right? [00:20:19] Dr. Dan Ginader, DPT: That's a big [00:20:20] difference between your two states of motion. And that difference introduces a [00:20:25] lot of risk for injury. [00:20:26] Dr. Taz: Interesting. So, so many people do think that way. They're like, and that's [00:20:30] probably the weekend warrior, right? Yes. Like, I'm gonna power it through these workouts, but I'm gonna like sit the rest of the time [00:20:35] and do everything else. Are there some basic hacks that you tell those type of [00:20:40] people to kind of put into their lives to help get like sneaky movement or [00:20:45] movement snacks, I think some of us call it so that there is more movement throughout any [00:20:50] given day so they're not susceptible to a pain, you know, a pain episode or an injury.[00:20:55] [00:20:55] Dr. Dan Ginader, DPT: I'll normally start with just asking them if they have a sit to stand desk. A lot of times, [00:21:00] especially here in New York City, if they work in office, a lot of times they have access to a sit to stand [00:21:05] desk, and if that is something you have access to, the general recommendation is you sit for 20 [00:21:10] to 30 minutes. [00:21:10] Dr. Dan Ginader, DPT: Then stand for 20 to 30 minutes and it's that back to forth, that back and forth, that has a really [00:21:15] good success. Also, the interesting thing about why standing desks are better than sitting [00:21:20] desks is that while you are standing, it's not the act of standing that makes you less likely for pain [00:21:25] or, or. [00:21:26] Dr. Dan Ginader, DPT: Anything like that, it's because standing is inherently [00:21:30] less comfortable than sitting without you noticing. You're shifting your weight back and forth. You're rising up on your [00:21:35] toes, you're shifting back on your heels. You're maybe doing some mm interesting, some little tiny mini squats, or because you're [00:21:40] already standing, you may like walk a little bit over here, walk a little bit over there. [00:21:44] Dr. Dan Ginader, DPT: And so it's that [00:21:45] constant movement that takes place while standing. That is actually the thing that makes standing [00:21:50] better for you. And so if you only have access to sitting. I suggest every [00:21:55] 30 to 45 minutes just do 10 sit to stands. Or every time you go to the bathroom, just do like 10 [00:22:00] pushups against the wall or try to find a way to [00:22:05] move and a way to do something every time you stand up anyway, so you don't have to kind of.[00:22:10] [00:22:10] Dr. Dan Ginader, DPT: Force it into your day or you don't have to feel like you're doing something you wouldn't have done anyway. But if you [00:22:15] already are getting up out of your chair, do some sit to stands, do some bridges, do some [00:22:20] just take three to five minutes and just move more and, and vary the movement and stuff [00:22:25] that small can start to really build up and make a difference. [00:22:27] Dr. Taz: I mean, I know we're talking about pain today and, uh, you know. [00:22:30] Pain and the experience of pain and, and what to do around it or about it. [00:22:35] But it's interesting, even when we have conversations around metabolic health or blood sugar, you know, [00:22:40] being sedentary is a part of the problem. And one of the things that I was looking at recently, [00:22:45] there's a really interesting study saying, just doing like 10 minutes of squats or [00:22:50] lunges or step-ups right before a meal will drop your blood sugar, you [00:22:55] know, a significant amount so that you don't store fat. [00:22:57] Dr. Taz: Post that meal. It keeps that, you know, [00:23:00] metabolic home going. And so it's interesting. It seems like, you know, should we be telling [00:23:05] people or should we be practicing like, Hey, for every hour you're sitting, you [00:23:10] know, walk for 10. Mm-hmm. You know? Does a strategy like that help when it comes to preventing [00:23:15] pain? [00:23:15] Dr. Dan Ginader, DPT: I think it can for sure, because like you said, it helps to quantify things for people. [00:23:18] Dr. Taz: Yeah. [00:23:19] Dr. Dan Ginader, DPT: I think the important [00:23:20] thing to, to keep in mind, and it's something that I tell my patients, is all you need to do is keep this up for two [00:23:25] and a half, three weeks. If you can just be regimented for two and a half, three weeks, I [00:23:30] guarantee that your body and you will feel a difference. [00:23:32] Dr. Dan Ginader, DPT: And then all you have to do is feel [00:23:35] that difference and then you're just gonna continue to do it all by yourself because it really is [00:23:40] obvious to you and the way you feel once you start doing it. And you [00:23:45] just need to. Get on the other end of that habit forming amount of time of that kind of like [00:23:50] two to three weeks. [00:23:51] Dr. Taz: Three weeks seems to be the magic number, doesn't it? Yes. Like the 21 days get to like [00:23:55] roughly 21 days and, and something that's new will become a habit and [00:24:00] become something that you crave at some point, right? It doesn't feel that hard anymore as we age. [00:24:05] It seems like we become more susceptible to pain. [00:24:07] Dr. Taz: Now, we have talked about how it's an issue now for [00:24:10] children and teens and young adults because everybody's sitting more, being sedentary is the number [00:24:15] one, you know, to use your words cause of chronic pain or cause of pain, you know? But [00:24:20] why does it seem like as we age we're even more susceptible? What's changing chemically or [00:24:25] physiologically? [00:24:25] Dr. Taz: What's going on there? [00:24:26] Dr. Dan Ginader, DPT: So I would say for the most part, it's just that as we get older and as we [00:24:30] age, we do just become. Less mobile. We don't move around as much as we get busy. A lot of our [00:24:35] busyness involves being on a computer, being on a phone, uh, and so we just move less. [00:24:40] You brought up metabolism a little earlier. [00:24:41] Dr. Taz: Yeah. [00:24:41] Dr. Dan Ginader, DPT: I think an important thing to bring up is that for the most part, your [00:24:45] metabolism doesn't really shift. Until you're in your fifties. [00:24:48] Dr. Taz: Mm-hmm. [00:24:48] Dr. Dan Ginader, DPT: And then the thing [00:24:50] that does shift is oftentimes how active you are, but outside of just becoming less [00:24:55] active, the thing that does change is arthritis is a very natural cause or a very [00:25:00] natural thing that happens just as you age. [00:25:02] Dr. Dan Ginader, DPT: Um. You do start to [00:25:05] lose height in between the discs of your vertebrae, you will start to to kind [00:25:10] of, you know, as your body slowly dehydrates over time, you will start to feel a little stiffer in the [00:25:15] ligaments. You will start to feel a little stiffer in the joints, but. The terminology that I use or [00:25:20] like to kind of steer people towards is that all this does is it reduces your margin for [00:25:25] error. [00:25:25] Dr. Taz: Hmm. [00:25:25] Dr. Dan Ginader, DPT: It's not a life sentence for pain. It's not something that you can blame for the [00:25:30] rest of your life just because you have a little bit of arthritis. It, all it does is that it reduces your margin [00:25:35] for error because it increases the amount of inflammation that's already present in those joints. [00:25:40] And so you have to work a little harder maybe to stay flexible or you have to work a little harder to.[00:25:45] [00:25:45] Dr. Dan Ginader, DPT: Maintain that mobility, but you can still stay ahead of that arthritis. And [00:25:50] then the third thing that I kind of try to drive home is that. There's a [00:25:55] very, there's very little correlation between what is shown on an x-ray, what is shown [00:26:00] on an MRI, and then what is felt in terms of symptoms. [00:26:03] Dr. Taz: Thank you. I think everyone [00:26:05] needs to, to hear that because many people come in so devastated or so [00:26:10] upset because an x-ray or an MRI are again, quote unquote, [00:26:15] normal, but they feel terrible and they want an explanation or want an answer. [00:26:19] Dr. Taz: What's [00:26:20] happening there? [00:26:20] Dr. Dan Ginader, DPT: So again, it goes back to how complex pain is and [00:26:25] especially when it comes to back pain where you have the discs and you have the nerves, and you have the facet [00:26:30] joints, and you have all the things that can go wrong in a back if you've lived 40, [00:26:35] 50, 60 years. If you go get an MRI, something's gonna. [00:26:39] Dr. Dan Ginader, DPT: Be [00:26:40] off something's. Mm-hmm. There's gonna be something that's a little degraded. There's gonna be right, probably a couple herniations. There's [00:26:45] gonna be, there's gonna something that's gonna be seen. But they've done [00:26:50] massive studies where they have done MRIs of people's backs [00:26:55] and then they have asked them, how much pain do you feel? [00:26:57] Dr. Dan Ginader, DPT: How much pain do you feel? And there are people that have [00:27:00] multiple levels of disc herniations, multiple levels of, of arthritis that report minimal to [00:27:05] no pain. And they have people that show perfectly healthy MRIs that have [00:27:10] really nasty levels of chronic pain. [00:27:13] Dr. Taz: Mm. [00:27:13] Dr. Dan Ginader, DPT: And they've run enough of these [00:27:15] studies that the overall point. [00:27:18] Dr. Dan Ginader, DPT: Is that your [00:27:20] pain has very little to do with what is seen on an image. Mm. And so it's [00:27:25] important to kind of detach yourself from that and then just focus on how you are feeling. 'cause [00:27:30] chances are, there are a lot, there are a lot of things that can be done to kind of change the direction of your symptoms.[00:27:35] [00:27:35] Dr. Taz: If you're listening to this and thinking, I know something is often my [00:27:40] body, but I don't know where to start. This is for you. That's why [00:27:45] I created the circle. The circle is my private community where I and my team focus on [00:27:50] understanding your body from hormones and stress to metabolic health and [00:27:55] longevity with real life guidance that you can actually use. [00:27:58] Dr. Taz: This is about clarity [00:28:00] and consistency and support beyond the exam room and maybe [00:28:05] outside of all the different appointments and experts that you've been running around to. You can try [00:28:10] the circle with a one month trial using the promo code [00:28:15] podcast@wholeplus.co back slash circle. Again, that's whole [00:28:18] Dr. Dan Ginader, DPT: plus HOL [00:28:20] ps.co/circle. [00:28:22] Dr. Dan Ginader, DPT: Alright, let's jump back into the [00:28:25] episode. [00:28:25] Dr. Taz: So when someone does have. Pain. If, if, if you can have standardization [00:28:30] across an image, right? Then what is, again, I'm just thinking about all the [00:28:35] doctors. You know, we give pain medicines, we write these prescriptions, are we [00:28:40] doing something wrong? [00:28:42] Dr. Dan Ginader, DPT: I mean, the whole pain medication, [00:28:45] opioid crisis is Right. [00:28:46] Dr. Dan Ginader, DPT: I think a whole, [00:28:47] Dr. Taz: that's a whole thing. [00:28:47] Dr. Dan Ginader, DPT: That's a whole thing. Yeah. That's a whole, yeah. That's a whole [00:28:50] different conversation. Right. But again, if, [00:28:52] Dr. Taz: but I mean, okay. Not to skim over that conversation real [00:28:55] quickly. Mm-hmm. Because I think the opioid crisis is real, and not to throw my profession under the [00:29:00] bus, but part of it was the. [00:29:01] Dr. Taz: Over-prescribing of these medications, right, to patients. For [00:29:05] example, when I delivered my first child, when I had my wisdom teeth out, I was [00:29:10] instantly given Percocets tunnel with codeine. I wasn't even sort of [00:29:15] coached in terms of like, okay. You don't need to take these, but these are just for an [00:29:20] extreme. [00:29:20] Dr. Taz: It was, no, you need to take these like every six hours for the next 48 hours [00:29:25] or X, Y, and Z is gonna happen. And being somebody who's like, I'm not taking anything, you know, I [00:29:30] never took them, you know? Mm-hmm. I kind of like, I don't need these. I'm gonna just. See how it goes. [00:29:35] But you know, for people who are following the doctor's orders and taking [00:29:40] medications for pain, when pain is a complex process that maybe doesn't need to be [00:29:45] managed with pain medications, like how, what do we tell them? [00:29:49] Dr. Taz: Do we tell them to [00:29:50] stop taking those medications? Do we tell doctors to stop prescribing them? Like, what's the [00:29:55] answer? [00:29:55] Dr. Dan Ginader, DPT: I think there already has been a shift to, to doctors prescribing the pain medication [00:30:00] less. Yeah. And. I think it just became the easy thing to do because pain is [00:30:05] complex, [00:30:05] Dr. Taz: right? [00:30:05] Dr. Dan Ginader, DPT: Getting rid of the pain is complex, but when you prescribe someone an [00:30:10] opioid. [00:30:11] Dr. Dan Ginader, DPT: It's a really easy way to mask it, and it's just, it's gone. Yeah. And it's, it's [00:30:15] done. [00:30:15] Dr. Taz: Yeah. [00:30:15] Dr. Dan Ginader, DPT: But the good thing is, is that, at least in my office and people that I've seen over the years, [00:30:20] they already want to get off of those. I mean, the, the idea of addiction and, and the people that [00:30:25] have an addictive personality and have, have fallen into the trap of those medication, that's a [00:30:30] story. [00:30:30] Dr. Taz: Right? Right. [00:30:30] Dr. Dan Ginader, DPT: But the people that don't have that addictive. Mentality or that [00:30:35] affliction, they want to get off the medication 'cause they feel sluggish and they fail out of it and they feel [00:30:40] bad and they, and they don't wanna rely on a pill. And so that shift, I think is [00:30:45] happening. And then it opens up the door for all the other things that people do have [00:30:50] access for, uh, in terms of reducing the pain without the use of medication. [00:30:54] Dr. Dan Ginader, DPT: And one of the [00:30:55] things that I consider the, the top tier a plus. [00:31:00] Outcome is when somebody tells me that they no longer need to take medication to deal with their pain. [00:31:05] And when, when we get to that point of care, that is how I know that I really made a A [00:31:09] Dr. Taz: big difference. A big difference. [00:31:10] Well, one of the things I'm curious about, should we be thinking about pain more [00:31:15] as a sign of inflammation and then that inflammation could be coming [00:31:20] from anywhere, right? [00:31:20] Dr. Taz: It could be emotional, it could be physiologic, it could be. Stress or [00:31:25] cortisol related, whatever. But if we think about it from the perspective of inflammation, [00:31:30] does that change how you. Take care of the patient or how the patient sees themselves. [00:31:35] [00:31:35] Dr. Dan Ginader, DPT: Yeah, so what you're talking about there is something known as the symptomatic threshold. [00:31:39] Dr. Dan Ginader, DPT: [00:31:40] So the reason that people can have arthritis but not necessarily pain is because our body is meant to [00:31:45] deal with a certain amount of inflammation before the body starts to read this as, oh, this should be [00:31:50] painful because it's, it's reached interesting, it's reached this point. And so what happens with arthritis is like, [00:31:55] let's say if you have a perfectly healthy joint, your, your symptomatic [00:32:00] threshold is. [00:32:01] Dr. Dan Ginader, DPT: Is here, but you are down here. If you have arthritis, you may come a [00:32:05] little bit up here, meaning that your margin for error just decreases a little bit. But I like the, [00:32:10] I like thinking of it in terms of that because people can wrap their head around that where [00:32:15] another thing, so going back to arthritis. [00:32:17] Dr. Taz: Yeah, yeah, yeah. [00:32:19] Dr. Dan Ginader, DPT: I'll [00:32:20] have somebody come in with back pain. They get an X-ray. They say, Ugh, I have [00:32:25] arthritis. And I say, well, when did you start feeling this back pain? The answer is, oh, two to three months ago, I [00:32:30] really started to feel it and I was like, well, I have. A spoiler alert, your arthritis didn't pop up two [00:32:35] to three months ago. [00:32:36] Dr. Dan Ginader, DPT: Arthritis is a slow process that happens over the course of years, [00:32:40] so that arthritis was likely present in your back for 1, 2, 3, [00:32:45] maybe even longer in terms of years, but you only started to feel pain two to three months [00:32:50] ago. That means that we can't necessarily blame the arthritis for the pain that you're feeling. [00:32:54] Dr. Dan Ginader, DPT: [00:32:55] You just did something recently to take that inflammation above the symptomatic threshold. But [00:33:00] because that only happened two to three months ago and because you were more or less pain-free for years before [00:33:05] that, there's nothing to say that we can't get that back below that point and get you back [00:33:10] to the point to where you can live more or less a pain-free life. [00:33:12] Dr. Taz: So it's a very different approach [00:33:15] to pain. It's looking more at, okay, nothing [00:33:20] really changed other than a tipping point that probably hit you. [00:33:25] What are the common tipping points for people? [00:33:28] Dr. Dan Ginader, DPT: I think, [00:33:28] Dr. Taz: let me say that again. What are the [00:33:30] common tipping points for someone to go from, you know, a regular injury [00:33:35] or a joint that maybe has had issues for years and years to now [00:33:40] something that is causing pain? [00:33:41] Dr. Taz: You know, and that could be an arthritic situation. It could be something like [00:33:45] plantar fasciitis, it could be something like the rotator cuff tendonitis that we [00:33:50] see a lot. How, what is what takes somebody from point A to point B? [00:33:53] Dr. Dan Ginader, DPT: A lot of times it's just [00:33:55] ignoring the signs. [00:33:55] Dr. Taz: Mm. [00:33:56] Dr. Dan Ginader, DPT: Very rarely will somebody go [00:34:00] from zero to a hundred outside of a. [00:34:03] Dr. Dan Ginader, DPT: A traumatic injury [00:34:05] without ignoring signs. I have a lot of people, let's say, let's use plantar fasciitis [00:34:10] as an example. [00:34:10] Dr. Taz: Yeah, yeah. [00:34:11] Dr. Dan Ginader, DPT: That they'll come to me. I've had this, I've had this foot pain for three months. [00:34:15] It's searing in the morning. It's, it's really bad. And then we start going back the months and months [00:34:20] before that and they'll say, yeah, I've always been a little weaker on my right side. [00:34:23] Dr. Dan Ginader, DPT: And oh yeah, I did have [00:34:25] like. A knee injury maybe like a couple years ago or, and, and I did have, [00:34:30] I was feeling like a lot of tightness in my calves, um, for like a, a year before [00:34:35] this. And it's, it's those kind of like little things that all of a sudden then [00:34:40] build to the point to where the thing that popped in, the thing that just no longer is, is.[00:34:45] [00:34:45] Dr. Dan Ginader, DPT: Being as forgiving is the area in pain. And, and in that case it's the plantar [00:34:50] fasciitis, but it was the, it was all of the ignored signs and symptoms that that got us [00:34:55] there. [00:34:55] Dr. Taz: What are a couple of signs and signs that we ignore? As busy people? [00:34:59] Dr. Dan Ginader, DPT: As busy people? [00:35:00] Yeah. We ignore the feeling of tightness. [00:35:02] Dr. Dan Ginader, DPT: Tightness. Okay. Or, or we ignore. [00:35:05] There are a lot of people that feel pain in their back after every time they stand up after sitting down for 15 [00:35:10] minutes. [00:35:10] Dr. Taz: Wow. Okay. [00:35:11] Dr. Dan Ginader, DPT: Uh, but they kind of almost resign themselves as to, oh, that's [00:35:15] just how I feel. Or, oh, it's because of my age. Mm-hmm. Or if they know they have something like arthritis, like, oh, that's just my [00:35:20] arthritis. [00:35:20] Dr. Dan Ginader, DPT: Um, but because they only feel it in fleeting moments. [00:35:25] They just either say it will get better or they resign to themselves that that's just how I [00:35:30] feel. And then they only come to a physical therapy office, or they only make a doctor's appointment when [00:35:35] it truly is limiting something that they need to do in their day to day. [00:35:39] Dr. Dan Ginader, DPT: They can no longer [00:35:40] drive the distance they need to get to work, or they can no longer go up and down a set of stairs. Something has. [00:35:45] I officially gotten to a breaking point to where they can't live their day to day, [00:35:50] but in the meantime, they were ignoring a lot of things that they were just feeling here or there that they thought would [00:35:55] either get better or just thought that that was the meant, the way they meant to feel. [00:35:57] Dr. Taz: So if you are noticing that you have some of these [00:36:00] signs, like, you know, you notice like your hip hurts a little bit or you have a knee that's out, [00:36:05] or your back is hurting, or your shoulders, you know, what do you do? Do you go straight to physical [00:36:10] therapy or do you need to do some sort of inventory of some sort? [00:36:13] Dr. Taz: You even mentioned, I [00:36:15] was thinking that the body gets dehydrated over time and that's a reason, you know, [00:36:20] to experience more pain. Do you start hydrating more? Like what are the things that [00:36:25] may be like, okay, here's some things I can do right now? [00:36:27] Dr. Dan Ginader, DPT: I think the general recommendation is if you've been [00:36:30] feeling anything for 10 days, about a week and a half, you should try. [00:36:34] Dr. Dan Ginader, DPT: [00:36:35] Something. There are so many resources available to you, whether it's social media or whether it's blog [00:36:40] posts, or whether it's a book. There are so many things available to you that will give you ideas on things that [00:36:45] you can change and things that you can try. And then I think the important thing is to try those [00:36:50] things and do them consistently and give it another 10 days. [00:36:54] Dr. Dan Ginader, DPT: And if [00:36:55] after those 10 days, if you haven't made a difference, then it's time to see a professional. [00:37:00] [00:37:00] Dr. Taz: What are some of the most common injuries you see in busy people? Let's, and we can even break it down a little bit [00:37:05] 'cause I know you take care of a lot of performers and dancers. I'm curious what you see in them, but what [00:37:10] about the executives? [00:37:11] Dr. Taz: What about the frequent flyers, you know, what about your, you know, [00:37:15] weekend warriors? What are some of the most common injuries that we see that lead to pain? [00:37:19] Dr. Dan Ginader, DPT: I would say neck [00:37:20] pain and back pain are the two most common injuries I see in busy people. And it [00:37:25] almost always ties down. It ties back to. How they're sitting. [00:37:29] Dr. Dan Ginader, DPT: Um, [00:37:30] if you are experiencing back pain, a lot of times it's because you are spending a very long [00:37:35] period of time with that lower back and a rounded position. [00:37:37] Dr. Taz: Mm-hmm. [00:37:38] Dr. Dan Ginader, DPT: And that rounded position can put [00:37:40] increased pressure through the disc. And then if you are never getting outside of that rounded position, [00:37:45] you're always kind of, again, you've reduced that margin for error. [00:37:48] Dr. Dan Ginader, DPT: And it can only take a little thing to get [00:37:50] to the point to where that disc may herniate or that disc may, may become painful. And then in neck [00:37:55] pain, it's kind of a similar, similar story where. A lot of people will. [00:38:00] Lose track of where their head is in space. They'll spend a lot of time with their head tilted one way. [00:38:04] Dr. Dan Ginader, DPT: Yep. They'll, [00:38:05] they'll kind of spend a lot of time, a lot of this. Yeah. Main stress response is like holding the shoulders [00:38:10] up. [00:38:10] Dr. Taz: Yep. [00:38:10] Dr. Dan Ginader, DPT: Um, and it's probably those two things that are the most common things that I see in just your [00:38:15] busy, everyday professional. So [00:38:16] Dr. Taz: neck [00:38:17] Dr. Dan Ginader, DPT: and neck and back, [00:38:18] Dr. Taz: neck and back. And the busy [00:38:20] professional. [00:38:20] Dr. Taz: Mm-hmm. What about the frequent flyer? [00:38:21] Dr. Dan Ginader, DPT: The frequent flyer is almost always back. [00:38:24] Dr. Taz: Back, [00:38:24] Dr. Dan Ginader, DPT: yeah. [00:38:25] [00:38:25] Dr. Taz: Upper, lower, [00:38:25] Dr. Dan Ginader, DPT: lower back. [00:38:26] Dr. Taz: Okay. [00:38:26] Dr. Dan Ginader, DPT: And as a, I'm six foot eight. Uh, [00:38:30] planes are kind of my, like the bane of my nemesis. Yeah. [00:38:32] Dr. Taz: Yeah. [00:38:33] Dr. Dan Ginader, DPT: Uh, they're not comfortable for me, but they, [00:38:35] they're also not comfortable for everybody. [00:38:36] Dr. Taz: Right. [00:38:37] Dr. Dan Ginader, DPT: Uh, and the thing that the plane seat kind of has in [00:38:40] common is that it's like, it's just like a flat plane seat. Right. And so there's, there's no way to get your [00:38:45] back in a way to where that, uh, that seat is providing any level of support. [00:38:50] And so your, your back is in this rounded position. It's in this. Not great [00:38:55] position for long periods of time. [00:38:56] Dr. Dan Ginader, DPT: And then because you are in this plane and in this [00:39:00] seat for hours and hours at a time, chances are you're just not moving. And so it's the combination both [00:39:05] of, of how you're sitting over and over and over in an unsupportive chair, and then the [00:39:10] amount of time that you're sitting without moving. And both of those things have, they just can do some nasty, nasty [00:39:15] work to, to a lower back. [00:39:16] Dr. Taz: So for the exec, for the busy person or the executive type [00:39:20] person, or the frequent flyer, and sometimes they're the same people, what are things you recommend for them to do [00:39:25] [00:39:25] Dr. Dan Ginader, DPT: if you're currently dealing with a back pain? I always suggest either having a travel [00:39:30] pillow or having a, a. Uh, a sweatshirt that you can roll up and place behind your back [00:39:34] Dr. Taz: on [00:39:35] your lower back? [00:39:35] Dr. Dan Ginader, DPT: Yes. [00:39:36] Dr. Taz: Okay, got it. [00:39:36] Dr. Dan Ginader, DPT: Because if you know that your lower back pain is tied to you sitting and sitting with a [00:39:40] rounded back, the best thing you can do is get it into a position of slight extension. And the easiest way to do that [00:39:45] is to put something behind your back. And a lot of people that sit on the plane and put something behind their back for the [00:39:50] first time, but you can see the lights go off and they can be like. [00:39:52] Dr. Dan Ginader, DPT: Oh, I was just spending too much [00:39:55] time in this one position. Now that I'm at back in this position, that feels much better. And then as, as [00:40:00] annoying as it may be, get up outta your seat once an hour. [00:40:05] Move around. Go to the ba. Just even just walk to the bathroom and walk back. [00:40:09] Dr. Taz: I can [00:40:09] Dr. Dan Ginader, DPT: sit, [00:40:09] Dr. Taz: sit [00:40:10] for four hours straight. [00:40:11] Dr. Dan Ginader, DPT: I know. Bad. I know. It's [00:40:13] Dr. Taz: so bad. So [00:40:14] Dr. Dan Ginader, DPT: bad. And if you don't [00:40:15] travel all that frequently, you're fine. And if you're not currently dealing with anything, it's fine. [00:40:20] But certainly if you are dealing with something. Getting up outta that chair, do some calf [00:40:25] raises, get some blood flowing. You don't even have to go to the bathroom, but walk to the back of the plane and walk back and [00:40:30] just breaking up that cycle of sitting can make a big difference. [00:40:32] Dr. Taz: Do you like red light therapy for [00:40:35] muscles and mobility and some blood flow? And just curious, I'm just [00:40:40] thinking like maybe we can build a plane which has a red light bet in it, but anyhow, but I was just curious what you're thinking [00:40:45] about red. You know, you feel like some of these modalities help. [00:40:48] Dr. Dan Ginader, DPT: I think modalities do have a place.[00:40:50] [00:40:50] Dr. Dan Ginader, DPT: And one thing that my girlfriend and I kind of butt heads over Yeah. [00:40:55] Is that she is a modality girly. [00:40:56] Dr. Taz: Okay. [00:40:56] Dr. Dan Ginader, DPT: She loves a modality. Yeah. She loves [00:40:58] Dr. Taz: give her a good red light bed [00:41:00] sauna full time. [00:41:00] Dr. Dan Ginader, DPT: She loves red light. She loves that. She loves, uh, she loves stem. She loves all of that. [00:41:04] Dr. Taz: [00:41:05] Yeah. [00:41:05] Dr. Dan Ginader, DPT: And. She is a, she was division one athlete. [00:41:09] Dr. Dan Ginader, DPT: Mm-hmm. She stays very [00:41:10] active. She understands all of the rules of movement and building strength. And so [00:41:15] for her, I think modalities are great. I just get worried about [00:41:20] recommending modalities to somebody who is already sedentary and already not moving. [00:41:23] Dr. Taz: Mm. [00:41:23] Dr. Dan Ginader, DPT: Because the mo, the [00:41:25] modality is not enough to move the needle or at least not move the needle [00:41:30] relative to how much, like building strength and, uh. [00:41:34] Dr. Dan Ginader, DPT: Building mobility [00:41:35] and building flexibility can, and so I think mod modalities on top of a very [00:41:40] active person that is, is taking active steps of building strength is fine, but I don't like recommending [00:41:45] modalities to people who are not at least willing to try that first. [00:41:48] Dr. Taz: So movement over modality a [00:41:49] Dr. Dan Ginader, DPT: [00:41:50] hundred percent [00:41:50] Dr. Taz: all the time. [00:41:51] Dr. Taz: Yes. When you're dealing with. Pain prevention or active pain. [00:41:55] Let's go to maybe some other strategies around managing pain, which we've now [00:42:00] described, you know, multiple times as a complex inner web system, [00:42:05] not a singular point where maybe you treat a singular issue. The challenge with that [00:42:10] in our current medical model is that that's not how we think about pain at all. [00:42:14] Dr. Taz: [00:42:15] And usually the way it goes down for most people is, you know, [00:42:20] presentation with pain. Pain medication of some kind. Doesn't have to be an opioid, but [00:42:25] some sort of pain management plan and imaging of some. [00:42:30] Kind, but there's not a lot of conversation around the role of inflammation, [00:42:35] the role of diet, the mind body component. [00:42:38] Dr. Taz: And one of the things that Whole [00:42:40] Plus is, you know, that we're so passionate about is connecting the dots for people. So, [00:42:45] you know, for somebody who is in one of these scenarios that we've talked about, right, where. Sitting a [00:42:50] lot, they're traveling a lot. They're a performer of some kind. They're using their body [00:42:55] either excessively or not at all, you know, and they're at a higher risk [00:43:00] of injury. [00:43:00] Dr. Taz: And that injury turning into a pain syndrome, you know, for those. [00:43:05] Folks as they're navigating their lives and then then navigating like [00:43:10] visits to practitioners. You know, what can we help them with? Like can we [00:43:15] give them or all of us something to really help us with, okay, this [00:43:20] is how we need to be thinking about it. [00:43:22] Dr. Taz: These are the things that you need to be advocating [00:43:25] for because an image and a medication prescription may not be [00:43:30] enough to take care of what's going on here. How can we kinda line that out? [00:43:34] Dr. Dan Ginader, DPT: So I [00:43:35] think that podcasts like this are really great resources for [00:43:40] people. 'cause I think it's really cool that there are so many different specialties. [00:43:43] Dr. Dan Ginader, DPT: I think it's really cool that I [00:43:45] know a hip specialist. I think it's really cool that I know a knee specialist, but. The hip [00:43:50] and the knee generally work as a unit. They're connected. They're connected. They one can't move without the other. [00:43:55] Right? Yeah. And if you are going through a hip, [00:43:56] Dr. Taz: you're a song. Your hip's connected to your knee. [00:43:58] Dr. Taz: What was like elementary school song? [00:44:00] [00:44:00] Dr. Dan Ginader, DPT: Right. I've [00:44:00] Dr. Taz: remember it. [00:44:01] Dr. Dan Ginader, DPT: We've known this for a really long time. Yeah. Um, and if [00:44:05] you see a hip specialist, they're only gonna talk about your hip. If you see a knee specialist can talk [00:44:08] Dr. Taz: about, [00:44:08] Dr. Dan Ginader, DPT: you need [00:44:09] Dr. Taz: the most frustrating thing in [00:44:10] medicine today. [00:44:10] Dr. Dan Ginader, DPT: Yes. And if you see a rheumatologist, they're only looking at one aspect of your blood work.[00:44:15] [00:44:15] Dr. Dan Ginader, DPT: And I think we've lost, unfortunately. I think the [00:44:20] old school family doctor, old school general practitioner, yes. [00:44:23] Dr. Taz: Thank you. [00:44:24] Dr. Dan Ginader, DPT: Was one of the most [00:44:25] valuable things that people had access to. 'cause it was one of the few people that looked at everything. [00:44:30] They would ask about your diet, they would ask about your exercise. [00:44:32] Dr. Dan Ginader, DPT: They would look at, we're [00:44:32] Dr. Taz: gonna say that again because I think that's so important [00:44:35] and I'm, and I love that you brought that up and not me, because I feel like I'm always screaming and yelling about that. [00:44:40] But the old school family doctor was the quarterback. [00:44:45] For someone's health and the health of that family usually, and [00:44:50] so could understand in the ecosystem, right, what might be happening [00:44:55] for that particular patient in their family. [00:44:58] Dr. Taz: Creating symptom X, Y, and [00:45:00] Z and what we have really found now, or landed in a place where [00:45:05] I think, you know, is scary when it comes to medicine, and this is where I say, yes, [00:45:10] absolutely, you guys are right. AI can replace doctors if we are going to practice [00:45:15] medicine like this, which is where there's, you know, there's a hand person, there's a hip [00:45:20] person, there's a head person, there's a heart person, there are all these people with no connector.[00:45:25] [00:45:25] Dr. Taz: You know, it's actually why I started Whole Plus. Not to plug Whole Plus right now, but, but it [00:45:30] is what I am so passionate about that we can't have healing journeys, [00:45:35] we can't get people better, we can't get families better until we start connecting the dots. And [00:45:40] I love that you're saying that as well. So not to segue, but, but anyhow, go back to what [00:45:45] can the patient do? [00:45:46] Dr. Dan Ginader, DPT: So if you are the kind of patient that is seeing a bunch [00:45:50] of these specialists, if you have a labral tear in your hip, [00:45:54] Dr. Taz: yes, [00:45:54] Dr. Dan Ginader, DPT: [00:45:55] go to the best hip specialist out there. Go to the person that is known for those surgeries. [00:46:00] Get your surgery done there. Follow the hip specific advice there. Do all of that. [00:46:05] Outside of something like needing a very specific surgery for a very specific problem, if you're the kind of [00:46:10] person that has a bunch of different specialists, which is very common here in New York, [00:46:13] Dr. Taz: yep. [00:46:14] Dr. Taz: Everywhere. [00:46:15] [00:46:15] Dr. Dan Ginader, DPT: I think it's important to recognize that medicine is far [00:46:20] more nuanced and is far more gray than you may like it to be. [00:46:25] And when you're dealing with a specialist that is used to work looking at one thing, you're [00:46:30] better off just taking their advice with a grain of salt than going to your other practitioner, taking their [00:46:35] advice with a grain of salt and then sitting back yourself. [00:46:38] Dr. Dan Ginader, DPT: And then unfortunately, you are now [00:46:40] in the position where you have to connect the dots, and it can be really tough if you don't have a medical [00:46:45] background. It can be really tough if you don't have other people that you can talk about this with, [00:46:50] but. I think the, the main, the main thing that is [00:46:55] hurting people right now, and this is something that I've learned especially working in the city and dealing with all [00:47:00] these people that deal with these, these specialists [00:47:02] Dr. Taz: mm-hmm. [00:47:03] Dr. Dan Ginader, DPT: Is they sought out the. [00:47:05] One of the world leaders. [00:47:06] Dr. Taz: Right. [00:47:06] Dr. Dan Ginader, DPT: I hear that too. Yeah. In, in, in their, in their field. And then they come [00:47:10] back and tell me that, oh, these, like they said, she said it was [00:47:15] this specific thing. And I was like, well, yes, like that specific thing is happening, [00:47:20] but what's to say that that specific thing isn't being inflicted because of the [00:47:25] lack of stability in your ankle? [00:47:26] Dr. Dan Ginader, DPT: Or what's to say that that specific thing isn't only bothering you because [00:47:30] your diet is not good or. So I am lucky enough to work with [00:47:35] patients on a one-on-one, a one-on-one hour long basis, and we get to have those discussions. Mm. [00:47:40] So we get to start at the source. I have enough time where I can start at the source, right? [00:47:43] Dr. Dan Ginader, DPT: And I can look at the thing that you came [00:47:45] in here with, and I can point out all the things that are wrong with it. And then as we go through this journey [00:47:50] together, as things get better and some things don't get better, then we have plenty of time for the [00:47:55] opportunity of. Oh, actually you did bring up that you had this knee injury. [00:47:58] Dr. Dan Ginader, DPT: Let's, let's kind of dive into [00:48:00] that joint, or I've noticed that when you stand on that on your left leg, you're just not as stable. [00:48:05] Or I noticed that, uh, you came and saw me at 4:00 PM and every [00:48:10] time you see me, you're maybe a little spacey, and I, I get to ask you, do you eat lunch before you come here? [00:48:15] Or when's the last time you ate before you came here? [00:48:17] Dr. Dan Ginader, DPT: And so we kind of get to, to tie the dots [00:48:20] together. [00:48:20] Dr. Taz: I think that's such an important point that you really do need to have that advocate. That [00:48:25] is listening and observing and understanding that the body's interconnected. If a [00:48:30] patient doesn't have that person, how do they advocate for themselves? [00:48:33] Dr. Dan Ginader, DPT: The squeaky wheel gets the [00:48:35] oil, and if you are not happy with the person that you're seeing, if you're not happy with your practitioner, [00:48:40] I think you owe it to yourselves politely, of course, to say, I don't think you're listening [00:48:45] to me. [00:48:45] Dr. Dan Ginader, DPT: I don't think that this is right. I don't think that this is right. And then you may have to find someone [00:48:50] else because if you are, if you're seeing a [00:48:55] practitioner. That is in and out in five minutes, and that doesn't take [00:49:00] the time to look through your, your medical binder of all the different images that you've had and all the [00:49:05] different experiences that you've had. [00:49:06] Dr. Dan Ginader, DPT: Then I think unfortunately it's time to find, to find someone new. [00:49:10] You just have to feel comfortable taking that agency over yourself and, and taking that [00:49:15] autonomy because we've kind of just like lost track of. How we can do that for people. [00:49:20] [00:49:20] Dr. Taz: You know, I think, um, at, at a minimum, I think people get really stuck in this idea [00:49:25] that something like pain or fatigue or, you know, depression [00:49:30] or anxiety, that these things are, you know, not singular [00:49:35] issues. [00:49:35] Dr. Taz: They are. Interconnected issues. Chronic pain will cause [00:49:40] depression and anxiety, right? Chronic inflammation will cause chronic pain. Depression and [00:49:45] anxiety are neuroinflammatory disorders. We can cut and paste this in lots of different ways, [00:49:50] but I think for the patient. What I'm hoping, and part of my motivation in bringing you [00:49:55] on is to really, you know, get that understanding. [00:49:58] Dr. Taz: What I want the patient to [00:50:00] understand is that including myself, all of us, what I want all of us to understand is that [00:50:05] a holistic approach to pain is necessary, and [00:50:10] I think from a cultural standpoint, even as patients, we have to shift our mindset [00:50:15] too. Right, because I meet patients all the time, like I went to the best, blah, blah, blah. [00:50:18] Dr. Taz: I went to the best [00:50:20] here. And they're running, they're like running in circles around the country, the city, the world, [00:50:25] whatever, doing that. But at the end of the day, the best of the best are only as [00:50:30] good as how connected they can create a plan for you to heal, [00:50:35] especially from something like pain. What is it that we [00:50:40] can do as we age to make sure we're pain-free? [00:50:43] Dr. Taz: What would you recommend? [00:50:44] Dr. Dan Ginader, DPT: [00:50:45] Move, [00:50:45] Dr. Taz: move. Just move on. It's your number one rule move. It's just move everyone off. We're sitting doing this [00:50:50] podcast. I know. We need to get up [00:50:50] Dr. Dan Ginader, DPT: and I'm already kind of getting to the point. I'm not sure how long we've been sitting, but I know it's time to move. My, my, my internal [00:50:55] clock is going off like, oh, I think it's time to, it's time to move. [00:50:57] Dr. Dan Ginader, DPT: I think it's time to fidget it a little bit. Or it's, or it's time to, or it's time to [00:51:00] move and it, I know I've said it a bunch here, but it truly is, it truly is the secret. A [00:51:05] body in motion stays in motion. If you see a 90-year-old person [00:51:10] that looks, that has good posture and they look strong. I [00:51:15] if, if they're your grandparent, spend a day with them. [00:51:18] Dr. Dan Ginader, DPT: I gu I guarantee [00:51:20] you they're not sitting for longer than 30 to 45 minutes. I guarantee you that if they're [00:51:25] sat for a while, they're getting up and they're going to the kitchen to do something or they're fidgeting around or I guarantee you, [00:51:30] if they're 90, if they're 90 years old and they're good posture and they're strong, they're running their own errands, they're going [00:51:35] on walks. [00:51:35] Dr. Dan Ginader, DPT: I bet you anything that they're social, I bet they have like a bingo club [00:51:40] or I bet they have like a reading club or I bet so. It truly is [00:51:45] movement. It doesn't even have to be exercise. Going back to that 150 [00:51:50] minutes that the American Heart Association recommends. They classify gardening as [00:51:55] moderate exercise. [00:51:55] Dr. Dan Ginader, DPT: They classify walking as moderate exercise. It doesn't have to be as [00:52:00] structured like [00:52:00] Dr. Taz: you're sweating and dripping or lifting super heavy weights. [00:52:03] Dr. Dan Ginader, DPT: Yeah. [00:52:03] Dr. Taz: Or something like that. [00:52:04] Dr. Dan Ginader, DPT: You just need, I [00:52:05] think the, the metric is like you just need to get your heart rate maybe in the triple digits somewhere. Mm-hmm. [00:52:09] Dr. Dan Ginader, DPT: [00:52:10] Which is, is pretty easy for most folks to do. And so you can even shift away [00:52:15] from thinking like. I have to you, you should be lifting weights, like resistance training is wildly important as [00:52:20] you age. It maintains bone density. It maintains strength. Uh, a big reason why, [00:52:25] you know, the, the likelihood of death after a hip fracture is, is about five [00:52:30] years. [00:52:30] Dr. Dan Ginader, DPT: It's not because the hip fracture is so. Traumatic. It's [00:52:35] because of the, the four to six weeks of bedrest that take place afterwards that if you [00:52:40] haven't maintained your strength and mobility and flexibility, that four to six weeks of bedrest [00:52:45] is, it can create enough atrophy and enough tightness to where all of a sudden you now struggle to [00:52:50] get in and out of a chair. [00:52:51] Dr. Taz: Wow. [00:52:51] Dr. Dan Ginader, DPT: And. That is why it's so [00:52:55] harmful. And so if you're maintaining strength, maintaining flexibility, maintaining your [00:53:00] movement, you are far more likely to be healthy in the long run. Strong in the long run, [00:53:05] and being that person that people will point to in the grocery store being like, wow, like I [00:53:10] bet you there. [00:53:11] Dr. Dan Ginader, DPT: They're in their nineties and look at how, look at how well they move. It's because they, it's [00:53:15] because they never stopped. [00:53:15] Dr. Taz: And that's such a message of hope and I, and I love that because it means that [00:53:20] longevity is movement and longevity is basically not being sedentary. Right. Let's do a quick, [00:53:25] rapid fire. [00:53:25] Dr. Taz: I know we're running outta time and I want, I definitely wanna talk about your book as well, 'cause that's newly out [00:53:30] too. But quick number one, diet rule to prevent pain or if you're in pain. [00:53:35] [00:53:35] Dr. Dan Ginader, DPT: More protein. [00:53:35] Dr. Taz: More protein. Number one movement rule. If you're having [00:53:40] or experiencing pain, [00:53:41] Dr. Dan Ginader, DPT: just do it more. [00:53:42] Dr. Taz: Where does sleep? [00:53:43] Dr. Taz: What would you say for folks [00:53:45] around sleep and stress if they're in chronic pain or experiencing pain? [00:53:50] [00:53:50] Dr. Dan Ginader, DPT: That I think can get a little more complex, but I'm a firm believer that eight hours is the [00:53:55] minimum. [00:53:55] Dr. Taz: Eight hours is the minimum. Mm-hmm. What about the people that skimp [00:53:58] Dr. Dan Ginader, DPT: with people that skimp? [00:53:58] Dr. Taz: I wouldn't know.[00:54:00] [00:54:00] Dr. Dan Ginader, DPT: If you're skimping and you're in pain, then there's a good chance that you're just not getting enough sleep because [00:54:05] healing takes place while we're [00:54:06] Dr. Taz: sleeping. While we're sleeping. So prioritize that sleep cycle. Mm-hmm. What is your [00:54:10] favorite modality? I know you're not a modality person. What is your. [00:54:13] Dr. Taz: Favorite modality [00:54:15] for different types of pain and injuries that you see What really actually [00:54:20] works. [00:54:20] Dr. Dan Ginader, DPT: It's a little controversial. Uh, in terms of this, like in terms of physical [00:54:25] therapists everywhere? [00:54:25] Dr. Taz: Yeah. [00:54:26] Dr. Dan Ginader, DPT: I do like a massage gun. [00:54:27] Dr. Taz: Massage gun. Okay. I [00:54:28] Dr. Dan Ginader, DPT: do like a massage gun. [00:54:29] Dr. Taz: [00:54:30] Okay. [00:54:30] Dr. Dan Ginader, DPT: I think that you can use a massage gun for just three minutes. [00:54:33] Dr. Dan Ginader, DPT: I think inside of those three [00:54:35] minutes, it creates enough of a change to where you can reduce your symptoms a little bit and encourage [00:54:40] movement a little bit more. And it's also easy to use. It's kind of very intuitive. Uh, [00:54:45] I am a fan of massage gun, but I understand that that can be a little bit controversial. [00:54:48] Dr. Taz: Best form of movement to [00:54:50] keep us living well into our sixties and seventies. [00:54:53] Dr. Dan Ginader, DPT: Variety. [00:54:54] Dr. Taz: [00:54:55] Variety. Okay. [00:54:55] Dr. Dan Ginader, DPT: There's not one perfect form of movement. The best form of movement is a bunch of different kinds of [00:55:00] movement. [00:55:00] Dr. Taz: Gotcha. Biggest emotional trap when it comes to pain and pain. Syndromes. [00:55:04] Dr. Dan Ginader, DPT: [00:55:05] Helplessness. [00:55:05] Dr. Taz: Helplessness. Say a little bit more about that. [00:55:08] Dr. Dan Ginader, DPT: The people that struggle the [00:55:10] most with chronic pain have resigned themselves to the fact. That, that is how they're meant to [00:55:15] feel and that's how they're gonna feel for the rest of their life. Wow. It's that sensation of [00:55:20] helplessness that keeps people trapped. [00:55:21] Dr. Dan Ginader, DPT: And then reason I try to find one small thing [00:55:25] to, to make a difference, and the reason that everything in the book, to plug the book [00:55:30] is so simple. Is because it's just meant to take that first step, and [00:55:35] if you can just take that one small step and make one small change, then it can just [00:55:40] shift that whole mentality from helplessness to a little bit of hope, and then you increase [00:55:45] your chances that you can continue on that journey enough to make a real difference. [00:55:48] Dr. Taz: Oh, I love that. So tell us about the [00:55:50] book. We haven't talked much about the book. The book is newly out. What are you hoping to accomplish in the book? [00:55:55] We have it sitting right here. [00:55:56] Dr. Dan Ginader, DPT: My goal with this book is that people will purchase it and keep [00:56:00] it in their house much in the same way they keep Advil or Tylenol in their house. [00:56:03] Dr. Taz: Mm. [00:56:03] Dr. Dan Ginader, DPT: Only now when they feel pain, [00:56:05] instead of reaching for the medicine cabinet, they reach for the book. They can reach for the book. Because I cover [00:56:10] every joint, I cover every muscle, and the most common causes of aches or pains in those areas. [00:56:15] I outline in very easy to understand language and in very short [00:56:20] segments why that? [00:56:21] Dr. Dan Ginader, DPT: It may be in pain. And then at the end of every section I give [00:56:25] very accessible and easy to do mobility, flexibility, and strengthening exercises to [00:56:30] start moving in the right direction. [00:56:31] Dr. Taz: Amazing. [00:56:32] Dr. Dan Ginader, DPT: So it is that, that level one access to [00:56:35] information, that level one access to, to exercise and movement, to get you back on [00:56:40] the road to moving in the right direct. [00:56:41] Dr. Taz: And the book by the way, is the Pain-Free Body and it's [00:56:45] available everywhere. Books are sold. [00:56:46] Dr. Dan Ginader, DPT: It's available everywhere. Books are sold. Uh, it came out last week and it [00:56:50] did temporarily sell out at Barnes and Noble. Oh, [00:56:52] Dr. Taz: wow. [00:56:52] Dr. Dan Ginader, DPT: It temporarily sold out at Walmart. [00:56:55] Uh, currently there is still plenty of stock at Amazon and we're working on getting it. [00:56:58] Dr. Dan Ginader, DPT: Uh, more stocked in, in Barnes [00:57:00] and Noble and Walmart. Incredible. But yes, it is, it is available theoretically, as long as it's not sold out [00:57:05] anywhere books are sold. [00:57:05] Dr. Taz: I'm probably gonna steal that copy. [00:57:07] Dr. Dan Ginader, DPT: Yes, it's all yours. [00:57:08] Dr. Taz: Uh, I do wanna ask you one final [00:57:10] question. I have loved this episode, by the way. I think that I meet people in pain. [00:57:14] Dr. Taz: My husband, as I [00:57:15] told you, has, uh, a little bit of a pain issue and I think. The message [00:57:20] that he gets from his providers or that my patients are hearing outside of my [00:57:25] exam rooms or exam rooms at Whole Plus is not often one that is [00:57:30] driven towards resolution of pain and pain syndromes, right? It is usually very fixated [00:57:35] on here's the injury, here's the image, here's the medication. [00:57:38] Dr. Taz: The end, and I [00:57:40] love that this conversation hopefully opens up the minds of both doctors and providers and patients [00:57:45] as well to think in a little bit of a different way. So thank you for that. I really appreciate it. [00:57:50] And for you, I wanna know what makes you whole. [00:57:52] Dr. Dan Ginader, DPT: What makes me whole? [00:57:55] I think it's movement and I think it's variety of movement. [00:57:57] Dr. Dan Ginader, DPT: Variety of movement. Yeah. I think [00:58:00] it's, I, I do try to practice what I preach and I do try to challenge [00:58:05] myself to move in different ways. It could be in the clinic, if I give a patient an [00:58:10] exercise that I've never really. Done for myself. I will try alongside with [00:58:15] them. Uh, my girlfriend goes to, she loves a group, Pilates [00:58:19] Dr. Taz: class. [00:58:19] Dr. Taz: Yeah. I'm right [00:58:20] there with her. [00:58:20] Dr. Dan Ginader, DPT: I'll go to solid core with her. Yeah. Uh, I try to, I try to find ways to [00:58:25] maintain that variety and then find out what I'm not good at. So I can work on it and get better, and then I [00:58:30] know that that will reduce my likelihood of, of being in pain and increase my likelihood of living a [00:58:35] strong and healthy life. [00:58:35] Dr. Taz: I love that variety of movement. Well, thank you so much for taking time outta your [00:58:40] schedule to join us today. I hope for all of you watching and listening to this episode, a whole plus, [00:58:45] you'll help someone who is suffering from pain and share this with them, and I will hopefully [00:58:50] see you guys next time. [00:58:51] Dr. Dan Ginader, DPT: Before you go, take a second to reflect on what stood out [00:58:55] for you today. Then [00:58:56] Dr. Taz: if you can leave a quick review wherever you're listening, [00:59:00] it really helps other people discover Whole Plus and start their own healing journey. [00:59:05] And don't forget to follow me on Instagram at Dr. TAs md. I love hearing how [00:59:10] these episodes are supporting you.