399: Chronic Pain: What’s Wrong With the Normal Approach and How to Fix It With Dr. Yoni Whitten

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Katie: Hello, and welcome to the “Wellness Mama Podcast.” I’m Katie from wellnessmama.com and wellnesse.com, that’s my new line of personal care products, like hair care, toothpaste, dry shampoo, and hand sanitizer. You can find all of that at wellnesse.com.

This episode is all about chronic pain, and everything the conventional approach gets wrong, and how to actually resolve it. I’m here with Dr. Yoni Whitten, who is an expert on movement. And he specializes in the permanent resolution of chronic pain. He’s a lifelong athlete and he’s seen firsthand how the body’s capacity for physical and mental adaptation can influence performance at every level. He is well-known for his work with chronic pain in his program in Pain Fix Protocol, blends the latest in scientific research with essential concepts from the field of natural movement, evolutionary health, spinal hygiene, and much more. So it goes beyond just treating pain, and especially treat effectively the whole person. In this episode, we really go deep on things like why 1.5 billion people are suffering from chronic pain worldwide, why people have knee joint replacements even on joints they’re not using, in fact, why that might actually be the reason, a surprising correlation between longevity and your ability to get on and off the floor. And why so much of the conventional approach to treating chronic pain doesn’t make sense when we think of pain as trying to tell us something important so that we can resolve it. I really respect Dr. Whitten’s work. This is really a fascinating episode, especially if you have chronic pain. But truly even if you don’t, it can help so much with posture and we can all learn so much from his approach to movement. So very fascinating episode. I know that you will learn so much. So, let’s jump in. Dr. Whitten, thanks for being here.

Dr. Whitten: Thank you so much for having me, Katie. I’m happy to be here.

Katie: I’m really excited to chat with you today. A lot of people listening may know of Dr. Ari Whitten, who is your brother. I love apparently genius just runs in your family. I’m so excited to have you on as well. I think you are an expert on a really important topic that, at least from my limited knowledge, is an increasingly large problem in society today. And this is the issue of chronic pain, which I’ll admit I understand not very much of and I think is, like I said, increasingly important to address and I would guess a very multifaceted problem with potentially a variety of solutions. But to start broad, can you walk us through maybe why we’re seeing chronic pain as such a large problem in today’s society?

Dr. Whitten: Well, you actually phrased that perfectly, Katie. So, kudos on that. It’s a huge problem. It’s absolutely multifaceted. Conservative estimates put about one-and-a-half billion people worldwide as suffering from chronic pain. The most common variety there is back pain, and about a one-third of that 1.5 billion, so 500 million people with back pain. And you’re not alone in what you said earlier at all, from the standpoint of not understanding a lot about it. It’s an extremely complex topic and it’s multifaceted, as you said.

I’m gonna give one perspective today. And my perspective is, the reason that chronic pain is such a big problem is it has a lot to do with the lifestyle that we’re living. We have a modern lifestyle that’s littered with what I call chronic pain traps. And those traps include everything from a sedentary living, which is completely out of character for how human beings have lived basically, throughout the existence of our species. We spend an abundance of our time in what are called flexion-based activities. We’ll get into this more later, I’m sure. But flexion-based activities are basically activities, where you are reverting back to fetal position. And the fetal position is a completely non-functional position. And if you look at the literature on it, it’s directly associated with multiple pain conditions, neck pain, back pain, headaches, some of the most common chronic pain conditions.

We also have, like, a very limited movement diet. So, human beings are omnivores, and we thrive on variety. And the same goes for movement. And what we spend our days doing is moving through very few movements and doing them repetitiously. We’re toxic with blue light, from what you and I are doing right now sitting in front of screens and insomnia rates reflect that. And then diet-wise, we have an extremely pro-inflammatory diet and we’re lacking in anti-inflammatory, omega 3s, things like that. And then finally, sense of community, sense of purpose. A lot of young people particularly are struggling with that, especially this year, with all the changes that we’ve seen.

Katie: Yeah, absolutely. And okay, so to touch on a little bit of what you just said, about, like, a low movement diet. And I feel like it’s important to differentiate too between movement and exercise because one thing I’ve realized, especially in the U.S., it seems like we think of those as the same thing. And we focus on exercise as being our main form of movement. Whereas as a mom, I’ve always felt like we could probably learn a lot from our kids who don’t exercise by the book at all, but who are constantly moving, and they don’t almost ever sit in the chair. They might squat in a chair, squat on the floor, climb something. Like, it’s so drastically different than adulthood, but, like, give us an idea of, like, the difference between movement and exercise, and maybe for adults, what a healthy movement, pattern, and diet would look like.

Dr. Whitten: Oh, beautiful question, such a good question. And I love that you went back to kids. When I have a quick examination in my office, I always say you should move like a five-year-old. So, five-year-olds move effortlessly in every direction. They rarely have ever experienced pain that lasts anything longer than they bumped their head on something and it goes away within a few minutes. But chronic pain for a five-year-old is an anomaly because they move so well. And because, as you said, they move in this variety of ways. Now, you said also they don’t exercise. They move because movement feels good and that’s the natural way for human beings to be.

I read a paper in the early 2000s from Dr. Cordain. And in the paper, they talk about a vast majority of chronic health problems, not just chronic pain, but chronic health problems in the United States could be resolved if only people would walk five to nine miles a day. And that’s a classic differentiation between movement and exercise. Exercise is structured. It’s regimented. And people think about instructions and doing it right. A lot of people don’t associate that with fun. And I think that’s part of the problem. Movement should be fun. So that I would say is the main differentiation if… I love what you said about moving like a child, you know, and having it be fun. Once you make that association between movement feels good, then you want to do it, nobody has to twist your arm.

Katie: That’s a really drastic statistic. I wanna make sure I heard that right. So if people would just walk five to nine miles a day, most chronic pain could resolve itself. Is that just because we would be, like, moving joints in the right amount and getting enough movement, in general?

Dr. Whitten: So that wasn’t a pain paper. That was actually… It was much broader. It was chronic health problems. So you’re talking about the majority of chronic health problems. Chronic health problems in the United States is the main killer. You’re talking about obesity, diabetes, heart disease, cancer. And they were talking in that paper, like some vast majority, like, something like… I’ll send you the paper if you like. But it’s something like 80% of modern-day health problems. You’re talking about all the overwhelm of our medical system is being caused by conditions that the majority of them could be resolved by walking five to nine miles every day.

Katie: That is even more drastic than I expected. That’s incredible.

Dr. Whitten: It is. It’s huge. And I would throw pain into that. I can’t tell you how many people with chronic pain conditions in my office I see, and they go on vacation, and they break their normal routine, and all of a sudden their pain goes away.

Katie: Wow, that makes complete sense.

Dr. Whitten: It totally does.

Katie: Fascinating.

Dr. Whitten: And that jumps back… I’m circling back to what you asked before about variety in the diet of movement. So, you know, you wake up each day, you jump in your car, you do your half-hour commute to your office. You sit in front of your computer, then you commute back for a half an hour, then you, you know, sit in front of the television. Well, your movement diet is pretty limited. You look for the closest parking space to make sure that you don’t have to walk as far. Take the escalator, take the elevator. You know, our bodies are built for movement. And one of the things that we’ll get into in a bit I’m sure is joints actually don’t have blood supply on the interior of the joint.

So one of the weird things, one of the things that’s always bothered me is why we see so much joint degeneration and the need for joint replacements among people that are sedentary. Like, how does that make sense? I run into people all the time who need a new knee or who need a new hip and yet, they don’t do anything. So how are they wearing out their joints? Well, they’re wearing out their joints because they’re not using them. It’s totally counterintuitive. But because the interior of the joint has no blood supply, it has nothing pushing nutrients to it in the absence of motion. You only get nutrition to joints through motion. So if you’re not moving, you’re getting almost no nutrients. And if you’re moving through a very limited motion, you’re getting very limited nutrients. So it would be like if you had a diet of only bananas, you know, it doesn’t work.

Katie: I’m, like, afraid of bananas. Some of my listeners know that’s one of my actual phobias. So that sounds like my literal worst nightmare.

Dr. Whitten: Like slipping on one?

Katie: No, just touching them, eating them, being around them. I don’t know what it is. I think I had an anaphylactic reaction to antibiotics right after eating a banana as a kid, but whatever it is, like, I see a banana and I’m like, “Ah,” right away.

Dr. Whitten: Wow, I used the best example possible just by accident.

Katie: Yeah, you cemented that one for me, for sure. Okay. So, I wanna get to tips for movement in a minute but I wanna go a little bit deeper on that first. I love that you brought that up because another podcast guest, Hunter Cook, brought this up as well. The idea that joints are different than a lot of areas in the body and that they are not vascular. They don’t have a blood supply directly into them. And I think this is a really profound, important thing to realize. And so like I would guess, based on what you said, not just do they need enough movement, but they need enough variety of movement because the same movement over and over would probably just be getting, like, nutrients to that specific part of the joint and not the entire joint. Maybe I’m extrapolating that wrong, but kind of explain what you mean by that.

Dr. Whitten: No, actually, what you said is spot on. There’s been a bunch of research out of China where they’re comparing… Because the United States has this incredibly high incidence of hip replacements on people that are inactive or have been inactive throughout their lifetime. So you’re saying, like, how are they wearing their hips out? And then they compared them head to head with aged-matched peers in China. And what their finding is something like 80% less need for hip replacements, as much as 90% less need for hip replacements in China for age-matched individuals. Absolutely fascinating.

And what they found what the difference is, is in China, one of the speculations for the difference, okay, so there’s definitely gonna be dietary factors. There’s definitely the fact that Americans tend to be much larger and heavier than the Chinese. We’ll take those off the table and acknowledge those. But one of the things that the researchers speculated for sure was that with an Eastern toilet, they squat. They get into a super deep squat, and they move that hip through its full range of motion by getting into and out of that very deep squat. And you figure you spend at least two minutes a day in that position every day and you’re providing more nutrients and you’re flushing out more waste products from those joints. So, you extrapolated that information exactly right. There’s plenty of data to support what you said.

Katie: Okay. So I feel like these two questions are probably gonna overlap. But I’d love to go deeper on some tips for working in movements. And I would guess that one of them probably is learning that deeper squat and using that position. I feel like this is a position many Americans don’t use at all. Like, I’ve read some stuff in passing that many of us can’t even get into a proper squat, much less hold it for more than a few seconds. And I’ll admit, this is a deficiency I have as well. I can actually… You could probably tell me why this is wrong. I can do it under a load. So with a weight, I can get into a deep squat and hold it for quite a while but I feel, like, unbalanced just holding a deep squat normally. I know this is an area I need to work on. But walk us through maybe the squat side, and then some other tips for movement as well.

Dr. Whitten: Sure. Well, let me address your question first as to why you’re having difficulty without a load on your back. It’s because of tissue tension and probably balance. So you’re maybe used to squatting with weights and not used to doing it without, I’m guessing. And the other thing is for women, if… Do you have a history of wearing high heeled shoes?

Katie: Not as much recently, but for sure when I was younger.

Dr. Whitten: Okay. So that leads to a thickening of the Achilles tendon. So interestingly, this is a funnier aside here, and we’ll get back on track in a second but women tend to wear high heels and they spend large sums of money, my wife included, much to my chagrin, to make their legs look good. And what happens is, when you wear those shoes over time, it actually causes a shortening of the calf and a thickening of the Achilles tendon. So high heels literally give you cankles over time. And there are studies that confirm that on MRI. So that’s one of those things that I just find ironic. But essentially, what you do is you get a shorter Achilles tendon and then it requires excess weight on your back in order to stretch that out.

Katie: That makes sense. And then, yeah, I noticed, like, my heels tend to come off the ground.

Dr. Whitten That’s what it is. So, that’s the tension in the calf and the Achilles tendon.

Katie: Fascinating.

Dr. Whitten: Yeah. I’ll give you another funny aside. When I remodeled my clinic, I wanted to install an Eastern toilet, which is, I don’t know how much travel you’ve done on that side of the world, but it was basically a squat toilet. And it’s part of my examination to get somebody into and out of a squat. It’s a super important position. Not to mention that cultures that get into and out of a deep squat and up and down off the floor because they eat on the floor, they don’t rely on furniture like we do here in the West. The Okinawans are a classic example. They’re one of the Blue Zones where people are consistently living to be over 100. And there’s research out of Brazil, group of researchers down there found that a person’s ability to get down and up off the floor unassisted, meaning without using your hands or your elbows to brace yourself directly correlates with longevity.

Katie: That’s fascinating. Does that work in reverse by improving those things and getting better at that? Does that correlate with longer life?

Dr. Whitten: I love your thought process. I’m gonna send you that article as well. So, my feeling is when… And this is the same way I address chronic pain. Anything that you can get working in your favor, improves your situation. So, I like to snatch up as much low hanging fruit as possible. It’s also stuff that just improves your quality of life. Think how limiting it is for a person when they say, “I can’t do that.” As soon as you said that mentally, your world is closing in on you. And that’s really the worst thing I would say about chronic pain is people’s worlds, they shrink in on them and to the point where, “Oh, I can’t do that. I can’t do this. I can’t do that.” And their quality of life essentially gets ruined and it’s way more debilitating than the pain itself in most cases.

Katie: Okay. So I’m putting a note to come back to, like, some really practical tips for movement at the end. But before we do, I wanna make sure we don’t bypass a few other questions I had related to chronic pain because I thought we jumped straight into movement, which I think I’m guessing is gonna be a big part of the solution. But it is definitely does not seem to be the common first line of treatment that people are getting a lot of times when they go in for chronic pain. So, let’s talk about what is the right now conventional common treatments that are happening when someone comes into a healthcare provider with chronic pain and then maybe some of the deficiencies that that has?

Dr. Whitten: Yeah, it’s actually a huge problem. And it’s a catch 22 also because the number one prescribed treatment is non-steroidal anti-inflammatories. That’s Advil, Motrin, Ibuprofen, things like that. And then the number two prescribed treatment recommendation is to rest or immobilize the painful area. Now, the reason why this is really weird is because there’s been guidelines, treatment guidelines that were developed by the American College of Physicians and the American Pain Society. So these are experts who have read literally all of the research on chronic pain. And their recommendations are staying active, using focus breathing techniques like Tai Chi or yoga, and then relaxation or meditation techniques. They specifically say for their tier one, that’s when a person comes into the system, non-pharmacological treatment.

So it’s in direct odds… The expert recommendations are in direct odds with what’s actually happening. And that caused “The Lancet,” which is one of the most famous medical journals in the world, one of the most well-respected journals to say, “Hey, there’s a huge mismatch here.” They did a huge pain study at the end of 2018, and they said, “Guys, what’s going on? We’ve got an enormous mismatch between what the research says and what we’re doing in hospitals.” And the conclusion from that study was, basically, we’re spending a lot of time, effort, money, and resources, and we’re making the situation worse for our efforts.

Katie: Wow, that’s really drastic, especially what you’ve already said about movement, the idea of, like, immobilize it and don’t move, it seems like the exact opposite, like you just said. Like, probably you should do gentle movements and work up to bigger movements and a wider range of movements. That said, from the little bit I’ve read, NSAIDs have a whole host of potential long-term problems on their own, right? These are hardly innert things they’ll just be taking every single day. Like, what are some of the long-term consequences that can come from that?

Dr. Whitten: Oh, geez. Well, I mean, every time you take it, you’re causing alteration of your digestive tract. Long-term, you know, the research shows that they’re responsible for over 100,000 hospitalizations each year for mostly gastrointestinal problems and they’re responsible for over 16,000 deaths a year. So, yeah, the consequences are no small thing. And also it’s not a coincidence that the American College of Physicians and the American Pain Society are specifically saying, “Don’t go that route.” But yeah, what you said is right. What’s taking place is directly at odds with what we should be doing.

Katie: And I’ve at least heard of some cases, typically, it’s start to more pain perspective, but then continues with chronic pain or people taking opioids and other even more intense painkillers, which I guess would be probably an even more severe, problematic solution that’s not actually fixing anything and probably creating a lot more problems over time, I would guess, right?

Dr. Whitten: You are 100% right. In about 1999, opioids started replacing non-steroidal anti-inflammatories. You know, basically, somebody would come into the system, they would get their own non-steroidal anti-inflammatory drugs. They would come back a few weeks later and if those weren’t working, then they would say, “Okay, we’re gonna throw more at this.” So we’re gonna go to opioids. So, from 1999 to 2010, there was a 400% increase in opioids prescriptions. And in that same timeframe… Excuse me, from 1999, until now, we’ve seen a 500% increase in deaths due to prescription opioid overdose. And we’re at the point now, where opioid overdose is the leading cause of death for Americans over the age of 50, I believe.

Katie: Wow. I had no idea it was that bad.

Dr. Whitten: Yeah, it’s pretty bad. And there’s another thing there, and this has come to light with all the lawsuits against the pharmaceutical companies, which is that a couple of researchers at the University of Colorado at Boulder found that taking opioids for five days actually led to an increase in pain intensity and duration.

Katie: Wow.

Dr. Whitten: Yeah, so you wanna talk about a smack in the face, okay, somebody is gonna give you a drug, they’re gonna charge you money for it, five days after taking it, it’s now proven that the drug that you’re taking for your pain makes your pain worse.

Katie: Wow.

Dr. Whitten: Yeah, that’s really all you can say. And you wanna hear a double wow on this. And I won’t go… I don’t wanna get into any conspiracy theory stuff because, in general, I don’t go down that route. But it’s pretty nasty when they’re giving you a drug that makes your situation worse and makes it longer lasting, which would encourage you to take more of the drugs. And then here’s what happens on the back end. The pharmaceutical companies get sued by these giant class-action lawsuits that are going on in states all across our country. And their stocks actually went up as a result of those lawsuits because the lawsuits were expected to be bigger than they were. In other words, they still came out ahead and it caused the stock prices to surge.

Katie: Wow.

Dr. Whitten: Yes.

Katie: Yeah. Oh, my gosh. So that’s, I mean, definitely a problem. I feel like, often, it’s like we need to take a 10,000-foot view and go back to kind of first principles. I’m a big fan of mental models and first principles. And I feel like maybe a lot of this stems from the idea that pain is a bad thing. So when someone comes in with chronic pain, they’re expecting relief from chronic pain. They want a quick solution. We know that’s treating the symptoms is a big thing going on across all aspects of medicine. But it also makes me wonder if the pain isn’t actually serving a purpose. Like, I find often, like, our physical reactions are great teachers. If we’re having digestive disturbances, sometimes that’s letting us know that something we’re eating is not good for us or that we need to fix our gut health. So it makes me wonder and I would guess from what you’ve already said, like, it’s at least telling us we need to move more. But is there an element of we’re thinking about this kind of all wrong, to begin with? Like, is pain the actual problem at all?

Dr. Whitten: Oh, such a beautiful… You said it exactly right. That’s actually one of the things that I really hoped that we would talk about it, and it’s this switch that’s taken place, where our focus has become completely on the pain itself, instead of, like you said, figuring out what the pain is trying to tell us. The idea starts at, is the body intelligent or is the body stupid? If you believe that the body is intelligent, then the signals that it sends you are meaningful. For example, if you have digestive disturbances, if you’re throwing up, you should probably ask, what did you eat or what did you have your hand on that you put on your face? Those are good questions to ask. And the same goes for pain. I would argue very strongly that if your hand is on a hot stove and your body is sending you pain signals to let you know that your hand is on a hot stove, then taking drugs to eliminate the pain while your hand remains on that hot stove is not an intelligent decision that’s in your best interest. Yeah? So, like you said, the pain is not the problem. The pain is letting you know that there is a problem. And that’s a critical distinction to make.

Katie: Yeah, I love that analogy of, like, if you’re burning your hand, you shouldn’t try to just get rid of the pain, you should remove your hand from the source of the pain. And then you still might have residual pain after and that’s a different thing you can address while you heal from the fact that you just burned your hand. But you’ve gotta solve the problem first. So, what are often some of the things that the body’s trying to tell us? And I’m curious if there’s also a potentially deeper meaning as well. I don’t know if this is accurate. But I’ve read, for instance, that, you know, people can have a bulging disc, which is considered a source of pain, and not even realize it and not be in pain. And other times people can have chronic pain and not have what appears to be any physical, like, thing that’s actually specifically out of place or wrong. So it tells me there might be something more going on here, to begin with. But what are some of the things the body’s trying to tell us when we have chronic pain in different areas?

Dr. Whitten: Sure. Yeah. It’s a really great question. Let me circle back just for a second and talk a little bit more about that because it is a subject that people should wrap their heads all the way around. So it’s strange that it works the way that it does. When somebody goes into the conventional medical system complaining of most aches and pains, the pain is treated as the pain is the problem. But if you’re going to see a dentist and you have tooth pain, you would never come out of a dental office with a prescription for pain killers only. You would never. If they did an examination, and they did their imaging, and they didn’t find anything, they would keep looking. They would keep looking until they found an explanation for the pain you are experiencing or they send you off to somebody who they felt was better qualified to figure out what your problem was. Those are the two things that would happen there.

Nobody in their right mind would come out of a dental office with a prescription for painkillers and think that that dentist had done their job. But in the conventional medical model, it’s accepted. Not only it’s accepted, but patients actually demand it. Give me something for this pain. Get rid of this pain. The average patient that comes into my neck has no… I should preface this. The average patient that comes into my clinic has seen about five to eight other practitioners before they get to me of various types. Most of them have no diagnosis, no accurate understanding of what’s going on with them. And they’ve been prescribed painkillers and they’re all scratching their heads wondering why they’re still in pain. So it’s a strange thing this… We associate it perfectly right in a dental setting and perfectly wrong in a conventional medical setting. And yet, it’s two parts of the same body. I don’t understand why that differentiation is made, but it’s there. To answer your question about what causes pain… So you brought up the example of bulging discs. You’re exactly right.

There’s studies that show, you know, with bulging discs. There’s studies that show with rotator cuffs. There’s studies that show with torn meniscus in the knees, that you could pull 100 people random off the street that have no pain and give them an MRI of their lower back and you’ll find a disc bulge. You’ll find an MRI of the knee, you’ll find 50% of them have a meniscus tear or, you know, 50% of them have a rotator cuff tear and no pain. So that has led to things like, say, Dr. John Sarno’s work, who’s a medical doctor, and he came up with this. He was working at a clinic in New York, I believe. And they were doing physical medicine. They were giving corticosteroid injections, nonsteroidal anti-inflammatories. And they were doing some exercise rehabilitation. And he was basically… I think he got upset with his results, He wasn’t getting the results that he wanted.

So he basically threw that all out and he said, “Hey, what’s the deal? We see these imaging studies where 50% of people with no pain have disc bulge, so disc bulges don’t cause pain.” He made a… He kind of went blanket statement on that and said, “Everything is caused by suppressed emotions.” So, he has a following of people, basically, outside of the medical establishment. Nobody’s published papers on his work. It’s been pretty much discounted, but it doesn’t mean he wasn’t right about some stuff. I would challenge, I would push back on one thing that you said there, I’ve never seen this, which is a person who comes in with chronic pain who passes a physical exam. So, in my mind, pain and a person’s ability to function, their ability to move are directly linked. And I find it hard to uncouple that link.

Katie: That’s fascinating. I’m glad you pushed back on that. So can you walk us through, what does that look like? What does a physical exam look like when someone comes into you with chronic pain?

Dr. Whitten: That’s a great question. The physical exam is actually as easy as pie, and everybody should be able to do everything that I would have a person with a physical exam. I’m looking at basic ranges of motion, how well a person can turn their neck, tilt their neck, turn their lower back, tilt their lower back, bend forward, bend backward, easy stuff, how easily can they squat down to the ground? How easily can they move their arms back behind them, and go up and down with their arms? Really basic levels of functionality. And I gotta tell you, in 15 years of practice, the amount of people that have passed my physical exam could be counted on one hand. And that’s of all ages.

I’ve got patients from 1 year old to 97 years old, and I’ve had less than 5 that have passed my functional exam in 15 years. One of the things that Dr. Sarno said in his book that pushed him to his theories was that, you know, he would say he would see patients who were complaining of horrible debilitating chronic pain, but they didn’t show any signs and no movement signs, they passed his physical exam. I struggle with that one. I’ve seen very high functioning people come close to passing a physical exam. And I’m not doubting that there are psychological, emotional, spiritual components to the chronic pain cycle. But in most cases, a person’s chronic pain will be detectable with a thorough physical functional examination.

Katie: And are most people having trouble passing this, would you say, from lack of movement? Like I said, it’s just simply a fatigue thing that we’re not achieving these ranges of motion, normally, so the body has limits in what it’s able to do at that point?

Dr. Whitten: There’s a fatigue component to it. The flexion-based activities that we touched on starting out, it’s a huge, huge problem. So, flexion-based activities, you’re looking down at your phone, you’re texting, you’re in front of a computer all day long, your head is poking out in front of your body, you’re losing the normal structure of the body. Normal structure is basically the presence of secondary curves. Secondary curves are what develop after birth. The primary curve is the fetal position. It’s how all of our babies are born, hopefully. And first secondary curve develops in the neck so that the baby can find mom and dad, food, and shelter, and comfort.

And so when that secondary curve comes in, they are finally able to look around. They’re finally able to start using their arms and reach for things, and things like that. But prior to that, when you’re in fetal position, you’re completely dependent on others for even your most basic needs. First secondary curve comes in the neck, you become more functional. Secondary curve comes in in the lower back, you can now sit up unassisted. You can begin to pull yourself up to standing position, and then you can begin to walk. The final secondary curve is in the bottom of the feet, which allows you to basically restore energy for more efficient walking.

So the loss of secondary curves, which we’re seeing on a massive scale in modern society, leads to joints not being lined up with one another the way that they’re supposed to, that’s joints throughout the body, not just the spine. It leads to a massive amount of fatigue, where for every inch that the head pushes out in front of the body, it gains an additional 10 pounds of weight that needs to be supported. Severe downward angles at the neck increase the weight of the head, so the head normally weighs somewhere between 10 to 12 pounds. When you get to like a 45 degree down angle, the head weighs 60 pounds.

So you’re talking about a person who texts or looks down at a laptop all day long, there’s definitely a fatigue element in that. But there’s also an element of, look, if a wheel is not round, it’s not gonna roll straight. It’s just not gonna roll properly. So, basically, we’ve got a bunch of people walking around, and 6 most recent studies on forward head position have indicated that somewhere around 70% of our population has forward head position at this point, that’s 70, which takes that 10 to 12-pound head makes it way heavier, pulls all the joints out of the spine out of alignment. When you pull the joints out of the spine out of alignment, the wheel’s no longer round.

So a person can’t even turn their head the way that they’re supposed to. You’re supposed to have 85, 90 degrees of motion when rotating your head to one side. The amount of people that even pass that portion of the exam is dreamily low. I mean, less than 20%. Less than 20% of my patients can even turn their head the full amount. Unfortunately, that’s just not a part of the conventional medical exam process. They don’t compare it to, they would say within normal limits. But we have a very unhealthy population. So, if you’re comparing it to other unhealthy people, you’re bound to fall short. The reason my exam process is more stringent is because I compare it to what normal is, what healthy is. And anything less than normal is abnormal.

Katie: That makes sense. I encountered that with… I used to have Hashimoto’s. And with thyroid testing, I went to many doctors. So, very similar to what you said, I had been to almost eight doctors before I finally found a practitioner who knew what they were doing and understood the root cause. So a lot of similarities there. But I had had all this thyroid testing and been told like, “Oh, no, this is a normal range.” And they were either testing only a couple of the hormones so they weren’t getting a full picture of what was going on or it was a normal range of people who get thyroid testing. But who gets thyroid testing? Either people over a certain age who are already having depressed thyroid function or people who suspect they have thyroid problems. So, that was the lesson I had to learn. And it sounds like there’s a very strong correlation here as well. It also sounds like posture is probably a much bigger piece of this than probably people realize. Like, if we’re spending this much time in our day in a certain pattern or, like, in a way that’s not healthy for our movement and is causing chronic pain, how big of a role does posture play and how do we start to correct those things?

Dr. Whitten: Yeah, it’s a wonderful question. Aristotle said, “We are what we repeatedly do,” right? So, we are an expression of our habits. If you’re spending all day in a fetal position, in a what I call flexion-based position, that’s activities where you’re seated, your head is down and your arms are in front of you and your hands are in a grasping position. So, essentially, you’re closing yourself down. You’re making the head heavier. You’re pulling the secondary curves out of the spine. You’re putting extreme strain on your postural muscles. You mentioned fatigue and kind of loss of fitness earlier, that plays a role when you talk about sitting in “ergonomic chairs,” where you’ve got armrests, and backrests, and headrests, and neck rest. Well, essentially, those rests or that furniture is holding your body, not you.

So, not only are you not using your muscles to move yourself but you’re not even using your muscles to hold the weight of your body up because the chair is doing all the work. So that’s the person who at the end, they work like a demon all day long, and then they try to get out of their chair, and they’re so stiff that they can barely move. Like Aristotle said, “That’s a person who’s adapted to what they’re doing their body.” The body is this amazing adaptive machine. And if you just do sitting in front of a computer working all day long, your body adapts to that position. And so you get really efficient in being in that position and really inefficient at doing other things.

Katie: That makes complete sense. I’ll show right now since we’re actually on video. But for people just listening, I have two of these. So I don’t sit on a stool. So I sit on a wobble stool, which at least I think is a little better at wobble so I have to constantly, like, stabilize, and I’m moving versus sitting still. But, yeah, I love that idea that, like, just… And I feel like for kids too. It makes me so sad to see kids like slumped over in desk all day long. And in our homeschool, this is something I’ve actively resisted. So we don’t have normal chairs at all. We have the, like, wobbly stools, but we also have like trampolines, and yoga swings, and surf trainers. And I much prefer them moving than sitting at all. It makes me the most sad with kids. But other than… So how do we address this? For people who have desk jobs or who do have to be in a stable sitting environment for a lot of the day, like, how can we start to address some of these problems? I would guess any amount of movement we can add in is probably helpful and good. But are there postural things we can do even within those constraints?

Dr. Whitten: Yeah, absolutely. It’s a great question. And I love the solution center thinking. Regarding what you said about your kids in the homeschooling, I love that. There’s a really good data that shows that when you get kids out of traditional chairs and put them on to exercise balls is what they used in the studies. But basically, you’re talking about a static surface to a dynamic surface. Concentration goes up, arousal goes up, behavioral problems go down, and test scores go up. So, really cool stuff. There’s been a bunch of TED Talks talking about people breaking writer’s block or wanting to improve their creativity, just going for a walk. So really good stuff on that.

As far as practical tips, I love what you’re saying there. And what you said is 100% right. Any amount of movement improves the situation. All you’re trying to do is think of your day as like a balance scale of being sedentary on one side and being in constant motion on the other side. You just wanna keep adding as many coins to the constant motion side as possible. Think of it as a cumulative thing. So, if you have to be sedentary at work and you work for somebody else, and your job is very rigid, I totally respect that. I get it. You gotta put food on your table. Park further before you get to your office. Walk a little further. Park a parking lot over. Park a little further down the street. At lunchtime, take a walk. Walk to where you’re gonna go eat lunch.

What you said about being on a dynamic surface versus being on a static surface, that’s huge. So you can’t see it here but I’m sitting on a hard wooden stool. It has no armrests and no backrest. And my body is required to hold this up here. And exercise ball. A sit-to-stand workstation so that you can vary your position throughout the day. And then taking constant motion breaks. And then when you do take those motion breaks, the strategy needs to be “Hey, I’m going in the direction of flexion-based activities all day long, so my motion breaks need to specific typically counteract flexion.” So I need to take my body into the opposite direction when I take my motion breaks. And that’s part of what’s missing is an understanding of doing and then a strategy that’s put in place to directly combat that.

Katie: That makes sense. I know you have a whole program for this. I wanna make sure we delve into that in just a minute. But I also have read a little bit about it and you can probably give a lot more clarity if this is true or not, but about posture, and how especially, like, being slumped over and rounding our shoulders, and getting in that kind of position that you’ve talked about, also has an impact on sympathetic versus parasympathetic and, like, the state of stress our bodies in, which that then would be tied to a whole cascade of hormones, and can affect sleep, and all kinds of other things. So if that’s actually accurate, I don’t remember where I read that, can you explain why that is and then how we can use that to our advantage maybe?

Dr. Whitten: Sure. Well, one of the things that I would say is that because we’re made to be in constant motion, sedentary living itself is actually a stressor. Anything that’s a stressor, we can think of it exactly the same way as that scale, with parasympathetic on one side and sympathetic on the other. Anything that is an influencer, that’s pushing you away from normal, normal is healthy, healthiest is homeostasis, meaning you’re in balance and your body is spending the minimum amount of energy to keep you healthy. Anything that’s a stressor pushes you away from homeostasis. So, we can agree on the terms there.

So when you talk about lack of motion, you’re already moving towards a sympathetic state because we’re designed to be in motion. So, the only way where lack of motion is not a stressor is if you’ve “earned your break.” Meaning, if you’ve just gone for a long walk, if you’ve just gone surfing, if you’ve just gone for a hike with your family, if you’ve just done these things, it’s perfectly acceptable to sit around because you’ve just expended a great deal of energy designed for this kind of thing. But what’s not normal is to sit around all day long. And we know this intuitively.

Like, if you wake up and it’s crappy weather outside, and you spend the whole day sitting on your couch watching QVC, and stuffing your face with potato chips, you haven’t expended much energy. You’ve been taking in a ton of energy from the food that you’ve been eating. But I would bet that if you had woken up and gone for a walk and expended energy, and then not eaten anything, you would actually feel more energized in the second example than you would in the first. Does that make sense?

Katie: It does. I love that comparison. Yeah. And actually, I’m a big fan of, like, time-restricted eating and water fasting. So I definitely noticed I have more energy when I keep that, like, calorie intake imbalance.

Dr. Whitten: Yes. Yeah. You’re exactly, right? But also our food intake is supposed to be coupled with energy expenditure. But it wouldn’t make sense at all if you’re laying on a couch and you’re taking in calories, you should be in a caloric excess. You should be overflowing with energy, right, versus if you just went for a hard walk and didn’t eat anything, you should be in a caloric deficit, and you should be tired, but it doesn’t work that way. And it doesn’t work that way because our brains are designed to function off of motion. So motion actually feeds our brain in the same way that wearing an automatic watch on your wrist, the motion of your hand and your arm feeds the motion of how that watch’s motor works. And if you take that same watch off and leave it on your dresser for two weeks, it stops working. Our brains function exactly the same way.

Katie: That’s a great analogy with the watch.

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Okay. So, you said we should for, like, correcting posture and with movement breaks, we should be focusing on movements that counteract the state that we’re in constant when we do have to set. What would be examples of some of those types of movements?

Dr. Whitten: So, the main thing I would say because back pain is one of the chronic pains, and you’re talking about somewhere in the neighborhood of 500 million people suffering from it, what I would say is go into lumbar extension, which is backward bending of the lumbar spine, which has gotten a totally bad rap and it’s total BS. Everybody tells you not to bend backwards at the waist. There’s nothing wrong. We’re supposed to have 30 to 35 degrees of backward bending in the lower part of the back. The curve bends that way. It’s perfectly obvious that our spine is designed to go that direction and there’s nothing dangerous about working in a normal 30 to 35 degrees range of motion in that direction. The classic example that most of your listeners will probably be familiar with would be an upward dog.

Katie: Okay. Yeah, that’s an easy one to visualize and to be able to implement. What about…? I’ve read a tip that it’s good to have, like, any kind of bar in your house and to just hang for some time throughout the day, that that’s really good for our shoulders over time. And I would guess that is an opposite of us having our arms just like down and at our sides, but is there any credibility to that?

Dr. Whitten: Yeah, there’s… Actually, I forgot the name of the book, I’m totally spacing on this one. But there was an orthopedic surgeon who was doing tons of rotator cuff surgeries. And like Dr. Sarno, he wasn’t happy with the results that he was getting. So what he did was he wrote this whole book, and instead of doing surgeries, he just prescribed a hanging routine for all of these patients who came in. And he was getting phenomenal results, just from that, just hanging. And again, this goes back to what you were talking about with your thyroid situation and what are you comparing yourself to with your results. So, the philosophy on the hanging is quite simple. It’s just that hey, we originated in primates and primates hang and that’s part of what’s natural for our species. So spending a little bit of time hanging in that position is very healthy. By the way, that’s the reason why that five to nine miles is also so powerful for influencing human health is because that was the norm for our species throughout our existence.

Katie: That makes complete sense. Okay. So, in just a second, I wanna make sure we, like, really delve into the specifics of your program. But before we do, I’d love to hear if you have any other tips for just incorporating movement. And I’ll share some that I’ve found in our house just because I realized, like I’m a creature of habit. And if I put something in my way, I’ll do it. But if it’s like often a separate room then I won’t necessarily remember. So, like, we had a gym room for a while, and I realized I could just forget it was there, conveniently not go there. And what we started doing instead was I put movement in our way all the time. And I’ll link to these in the show notes. Down our hallway, we have a gymnastic track now.

So the kids don’t ever walk down the hallway, they somersault or handspring or flip down the hallway. And in each of their rooms, they have gymnastic springs and yoga swings. And then we have, like, in most of our archways, like the fingertip hanging things for rock climbing, and then just like other really balanced type things in the way and then we try to sit on the floor as much as we can versus sitting in chairs. And that’s made a big difference for me over time of, like, my range of motion, but I had to, like, be really intentional because it wasn’t… Like, it was easy just to sit at my desk or sit at the table or I had to kind of get creative to get myself out of that. Do you have any tips for incorporating movements and what would be a good kind of ratio of how much indifferent types of movements we need to try to incorporate?

Dr. Whitten: Yeah, I mean, it’s a wonderful question. I steer away from, generally speaking, specific prescriptions from mounts because it depends on what that person’s starting point is. So, wherever they’re starting from, I just want them to focus on doing a little bit more than they’re currently doing. So, that’s my general recommendation. My overarching statement that I make to all my patients that will come in is every joint in your body needs to be moved through every range of motion it has every single day. So every joint, every range of motion, every day. That’s part of what my program teaches people how to do.

The other thing that I say is put on your mask first. I use the airline analogy where you’re the parent, if you lose cabin pressure, you need to put your oxygen mask on first and take care of yourself before you can start helping your kids because if you pass out, you’ve now become an asset…excuse me, you’ve now become a liability, not an asset. So, you need to be taken care of first so that you can then go on and do what you need to do. And how I incorporate that is to have people start off their day with a basic movement routine. And that’s what I have all of my patients and all of my Pain Fixed Protocol community members start their day and finish their day with caring for their physical body, not unlike the way people do with brushing and flossing their teeth.

Everybody knows that if you wanna keep your teeth healthy, and your gums healthy, and maintain them for a lifetime, then you need to brush and floss your teeth two to three times a day. It’s common knowledge if you start getting dental problems, and gum problems, and gingivitis, and all these things, you should probably start with the basics. Just brush and floss your teeth every single day, multiple times. And so that’s what I do with movement. I’ve taken a very similar model. I have a lot of admiration for what the dental community has done. They’ve boiled it down to a very simple message that everybody knows simple tools that are used on a daily basis day in and day out over time, make the difference between who’s successful and who isn’t. And that’s the kind of stuff that I really love to use.

Katie: That’s a great analogy. So I haven’t ever had, like, chronic back pain but my dad did for a lot of years and I saw how uncomfortable that was, and how much of a toll it took on him to be constantly in pain. And I definitely have empathy for anybody who’s there. How quickly can people if they’re committed to this and start implementing positive movement patterns, how quickly can they start to see changes and start to feel relief?

Dr. Whitten: That depends on where the person’s starting from. But basically, as soon as you start, I always say the person’s in pain is in a hole. And so, before we can even start working on their health status, we need to get them out of the hole that they’re in and getting to get them back to neutral. So, like, I always use a painting analogy. Like, the picture that’s been painted is not what we wanna see. So we’re gonna kind of get it back to just a blank canvas, and then we can start painting the masterpiece. But I mean, jeez, I have patients…community members who have said that just within five days, people are seeing a difference. I have other people that take a few weeks.

The program itself, I offer a 30-day money-back guarantee on it. I’m not saying that to plug the program so much as I’m saying it because I feel that that window of time will be enough for most people to see results. Enough results should be seen within those first four weeks that they should be incurred, continue with it, and to get deeper into it. And really, you’re just scratching the surface there. But usually, that’s enough time to see some positive changes, and not just in the amount of pain that they’re experiencing, but to tie that pain to their functionality, which directly correlates to quality of life.

And so, what they should be saying is like, “Oh, hey, wow, I can turn over my shoulder when I change lanes and make sure that I’m not gonna crash into a car,” and things like that. You know, “I can reach up over my head and take things down out of the counter.” They start saying to themselves, “I can do this,” instead of, “I can’t do this,” and their world starts to open up. So, I usually find that 30 days is enough for them to get a little taste of that.

Katie: That’s awesome that it can be that rapid. I’ll make sure we have a link in the show notes to that so people can find it. But just walk us through a little bit more where people can find that and, like, what they can expect when they enter your program. Because I know you do work one-on-one with people but you’re in the San Diego area. But anyone who’s not in your area, can do your program anywhere in the world, right?

Dr. Whitten: That’s exactly right. So, that was actually why I developed the program. It was my brother’s urging, he’d been prodding me for years, and I gave him so much resistance on it because I’ve been in practice for 15 years, and I love working with people one-on-one. And I didn’t feel like I could do justice to the process via an online program. And my brother made the point, which was a great point that I’m very limited in who I can work with in my practice. It’s mostly limited by proximity.

So, we created the program, and like I said a minute ago, I wanted to use that dental model, where if I just give people these simple tools and they implement them consistently, and with what’s called the principle of progression, which anybody who’s familiar with resistance training would know or training for a marathon, right? If somebody’s training for a marathon, they’ve never run before in their life, start them off with 26.2 miles because they’ll never run again and they’ll hate your guts. You start them off with maybe a lap around the track, a quarter of a mile, you know. And then you slowly build up over time because the body adapts to what you give it and it will modify itself to accomplish the task that you’re giving it. So that’s the same principles that we use in the program.

What they can expect to get from the program is it’s gonna teach them to uncover structural and functional issues that are contributing to their pain problem. So this is one thing that we haven’t touched on yet but what you said earlier is exactly right. There are emotional components. There are psychological components to chronic pain. It couldn’t be otherwise for a situation say somebody like your dad who is in chronic pain for a long period of time. Chronic pain is directly linked to depression. And how could it not be? You’re saying to yourself, “I used to be able to do this. I can’t do this. I don’t know what to do about it. If I’ve gone the conventional medical route, they’re telling me to rest, and immobilize myself, and they’re giving me drugs that in some cases make the pain worse.” Yeah, I could see how that would make a person depressed. You lose hope, which is where a sense of depression sinks in.

When you influence the pain cycle, so you have pain on one end. You have your depression psychological-emotional component to that. You have an inflammation going on a cellular level. You have digestive upset. You have increased stress response, which you touched on, and I didn’t jump into that, which I can jump into a little bit now. But increased sympathetic, all of that is being influenced, if you come in and positively influence any one part of that cycle, you’ve now positively influenced the whole cycle. So you’ve taken that person and you’ve shifted them in the direction towards health. That’s the goal of the program. The program teaches people how to uncover structural issues, functional issues, sleep-related issues, and some lifestyle-related issues that are contributing to their problem.

And then they are taken through a series of self-assessments, where it’s not a one size fits all. Each person can figure out which specific parts are affecting their situation. And then there’s a series of strategies, depending on how you answer those components that will take you in through a two-month-long corrective phase for addressing all those issues. So we address sleep issues, we address structural postural issues, and we address functional issues. There’s also a light therapy issues where we teach people to turn their body into basically a healing machine and ramp up their metabolism to get their body working in a direction, where if there is damage in the body, we can repair that, as well as some mindfulness and relaxation techniques where they can retrain their mental associations with their pain. So I brought in experts to teach those parts of the program. And yeah, there’s a lot of good stuff in there.

Katie: I love that you also touched on just that mental component of when you feel like you can’t do something and how limiting and frustrating that is versus the empowerment that comes with realizing what you can do. And not in a chronic pain way but a related way. I’ve had that experience the last couple of years after losing a significant amount of weight, and also just rediscovering my body post-kids versus pre-kids. I have been pregnant and nursing for so long, I just hadn’t done a lot of different activities because you are somewhat limited in those times. And I realized, like, I didn’t like being upside down. And so I had this, “I can’t do that. That’s too hard,” or whatever.

And I also had this script in my head from my parents that I wasn’t an athlete because they always really wanted us to focus on academics. And so I had this script that was just constantly playing in my head. And I really have had fun challenging that the last couple of years. And it’s been so fun to get to see how quickly the body responds when you start using that progression model like you talked about. I’m using it with weight training, which is how rapidly the body can adapt. It’s absolutely incredible. And I would guess most people are probably equally surprised when they start doing this from a chronic pain perspective, just how incredibly rapidly the body can start to respond when you give it the right inputs. It’s drastic. It’s amazing.

Dr. Whitten: It is. It is. And the people who are not in that progression model, the person who’s saying they’re seeing where they’re starting from and then they’re seeing their end goal, this leads to more failure than I can tell you. I mean, if you’re trying to run a marathon and you’ve never run a day in your life, 26.2 miles is a long way. I don’t run marathons, 26.2 miles seems like a long way to me, and I have no desire to do it. But if I did wanna do it, I would start off with a mile, and then I would work my way up.

I read a story about a guy who was climbing… He was a mountain climber in… They were on the North Face in Europe. And he had gone out with his climbing partner. And they were attempting this very difficult face. And, at some point, the rock gave way, they both took a bad fall. One of them died. The other one broke both of his legs and pelvis. And he thought he was gonna die, He laid there. I don’t remember the length of time. He laid there in the snow, just kind of wallowing waiting to die and he didn’t. Finally, he sat up, he realized he wasn’t gonna die and that he needed to make his way back to the camp. It was about 12 miles away. He couldn’t walk. He’d broken both of his legs. So he sat in an L-sit where his legs are out in front of him and he used his arms to push himself. He was going backwards. And he was pushing himself through deep snow.

And he said that the only way that he survived it was he would poke head up, turn around, and identify a boulder or identify a mound of snow, and he would say, “I’m just gonna make it to that mound of snow.” And doing that, he gave himself little on the back each time he would hit one of those small goals, the incremental steps on the way to his big goal. And doing that, he dragged himself back to camp and saved his own life. And that’s the same thing with progression. You set little incremental goals for yourself, and in that, you take this huge insurmountable task and you chunk it down into these little manageable steps.

Katie: I love that and I love how you make it so doable. I know you’ve helped so, so many people with this. And like I said, all the links for people to find you will be in the show notes at wellnessmama.fm. You have so much information on your website. I would definitely encourage people to stay in touch with you and learn from you. And I love that you brought up the longevity thing because even those of us who are fortunate to not have chronic pain, that really is a drastic thing that you mentioned with that connection to longevity. And I feel like they also drastic it’s really struck out to me is only five people or less have ever passed your physical exam to begin with. I would assume many of them hopefully get there over time. But it means we all have a lot of room for improvement. Even those of us not in chronic pain can learn so much from improving our movement and improving our posture. Another question I love to ask at the end of interviews, somewhat selfishly because I’m always looking for recommendations is if there’s a book or a number of books that have had a dramatic impact on your life, and if so what they are and why?

Dr. Whitten: Great question. I’m an avid reader. You can probably see the bookshelf here in my office. But if I had to choose one, I would say “The Wellness and Prevention Paradigm” from Dr. James Chestnut. He’s absolutely brilliant. A chiropractor out of British Columbia. Fascinating. I was introduced to his work. When I was in my residency in school, I was in the clinic, somebody passed me a CD, so I’m dating myself here, of him speaking. And I heard him speak. I just… I was wrapping up four years of chiropractic school, I heard this guy speak and I went, “Wow.” I heard five minutes of him speaking and I said to myself, “This guy, I need to learn more from.” So I did a one-and-a-half postdoctoral program under him. And his model of understanding health is absolutely paramount to anybody who’s struggling with chronic health problems in my opinion.

Katie: I love it. That’s a new one that has not been recommended before. So I will check that one out and the link to that as well will be in the show notes. Dr. Whitten, thank you so much for being here. Like I said at the beginning, I think this is such an important topic and such a life-changing one for people who are struggling with chronic pain, and I appreciate all of the work that you do and all the people that you’ve helped.

Dr. Whitten: Thank you so much for having me.

Katie: And thank you as always for listening and sharing your most valuable resource, your time, with both of us today. We’re so grateful that you did, and I hope that you will join me again on the next episode of the “Wellness Mama Podcast.”

If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.