Physical Medicine and Rehabilitation Sports Medicine

January 16, 2015

taitEveryone knows that exercise is an important component in maintaining a healthy lifestyle. However, injury can be an unfortunate consequence from exercise and sports. The Centers for Disease Control and Prevention as well as the Department of Health and Human Services estimate that over 2 million people are treated in emergency rooms for sports related injuries each year. As a result of these injuries and/or other physical injuries, physical rehabilitation can be necessary. Additionally, when an individual is looking to adopt a healthier lifestyle, they may seek the advice of experts about making this switch as well as how to maintain it. Therefore, we have Jonathan Tait, DO to answer a few questions regarding these topics. Dr. Tait is a 2004 graduate of Michigan State University College of Osteopathic Medicine and has practiced in Tucson since 2010. He is board-certified in Physical Medicine and Rehabilitation by both the American Board of Physical Medicine and Rehabilitation and the American Osteopathic Board of Physical Medicine and Rehabilitation. He is also board-certified in Sports Medicine by the American Osteopathic Academy of Sports Medicine. Dr. Tait is the President, Medical Director at Rejuv Medical Southwest, located at 7790 N. Oracle Road, Suite 150. The telephone number for his office is (520) 777-9385.

Q-What are the common reasons people end up in your office?

The most common reason patients come to my office is because something hurts as a result of an injury, either new or old. Due to the pain they are typically not functioning as well as they would like to be, and this has limited their overall enjoyment in life. Maybe they are limited with recreational activities such as hiking, cycling, running, golf, or tennis. Or maybe for the "do it all super-mom or super-grandma", they just can't keep pace with all of the activities of daily life that must be checked off the list each day.

People also seek us out because we have established a reputation of delivering more comprehensive treatment programs. Although our initial focus will be to treat the injury, decrease pain, and improve function, at the same time we are identifying other aspects of the patient's health that may be limit the ability to recover quickly.

Other people land in our office because they have goals to lose weight, move better, get stronger, and become a more active participant in life. We have programs specifically defined to train clients of all ages and all abilities.

Q-Do you see a lot of patients for pain?

Yes. This is the number one complaint that brings people into my office each day. Sometimes it is a recent injury such as an ankle sprain sustained while running. Or, the painful condition may be more persistent pain, such as lingering pain or limited function following a joint replacement or spine surgery. Whether a recent or remote painful injury or condition, one that comes and goes or is unrelenting, I have treatments to offer for all patients who seek to get out of pain and stay out of pain.

Q-What is the physical medicine specialty and how does it differ from sports medicine?

Physiatrists, or rehabilitation physicians, are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move, feel, and function. Rehabilitation physicians are medical doctors who have completed training in the medical specialty of physical medicine and rehabilitation (PM&R). Specifically, rehabilitation physicians:

• Diagnose and treat pain
• Restore maximum function lost through injury, illness or disabling conditions
• Treat the whole person, not just the problem area
• Lead a team of medical professionals
• Provide non-surgical treatments
• Explain your medical problems and treatment/prevention plan

The job of a rehabilitation physician is to treat any disability resulting from disease or injury, from sore shoulders to spinal cord injuries. The focus is on the development of a comprehensive program for putting the pieces of a person's life back together after injury or disease - usually without surgery. Rehabilitation physicians take the time needed to accurately pinpoint the source of an ailment. They then design a treatment plan that can be carried out by the patients themselves or with the help of the rehabilitation physician's medical team. This medical team might include other physicians and health professionals, such as neurologists, orthopedic surgeons, physical therapists, massage therapists, acupuncturists, behavioral health professionals, etc. By providing an appropriate and understandable treatment plan, rehabilitation physicians help patients optimize their health and function, to remain as active as possible at any age. The goal of treatment is to add quality life to your years, not just years to your life.

Q-What is a "sustainable lifestyle intervention?"

I use this term during my visits with patients to discuss small, consistent changes in their lifestyle that can be managed long-term, and have a huge impact on injury recovery or health. As an example, extreme, fad diets may work for short-term weight loss, but for a lot of people they find the diet too difficult and unsustainable. After a while they end up sliding back into old habits. The initial gains they may have seen with the fad diet quickly fade away, and now they are more confused and frustrated about how to keep the weight off long-term.

My treatment plans are rooted in sustainable lifestyle interventions:

• Nutrition counseling
• Exercise programming
• Stress reduction
• Sleep quality improvement
• Strengthening of positive, supportive social networks

Epidemiological studies have shown time and time again that when these five factors are optimized, longevity is dramatically increased while the incidence of chronic, debilitating medical conditions are dramatically decreased.

Setting off on a course to exercise two hours every day is not usually going to be sustainable for most people I see. On the other hand, committing to carve out 20-30 minutes each day for exercise is manageable, sustainable, and when done consistently, can greatly improve your overall health.

Often times, the interventions utilized in medicine, such as medications or injections, are intended to be short-term interventions, not lifelong therapies. I use them to create what I call a "therapeutic window". In a sense the medications or procedures are used to quickly decrease pain, improve sleep, or help manage stressful situations. They are be used while the patient is being guided through the necessary changes in lifestyle. In time, with adoption of the required positive lifestyle changes, many of the medications and injections are no longer needed to treat the problem. However, if patients don't put a lot of effort into prioritizing their health and making some changes in their life, then sadly many become very dependent on medications or procedures as "the fix".

Q-What are some simple guidelines people can follow to avoid injury and disease in everyday life?

Number one - don't eat junk. Number two - get some form of moderate level exercise every day for at least 20-30 minutes.

We should all consider that the function of every cell in our body is greatly enhanced by these two things. The foundational nutrition we put in our body becomes the building blocks for every cell, tissue, and organ system in the body. Our bodies are also meant to move, not to sit behind a desk for 8-12 hours each day. Exercise is medicine. Amongst a multitude of positive benefits, studies have shown that exercise is just as powerful as antidepressants in elevating mood and can have positive effects on pain due to release of natural pain-killing compounds called endorphins and enkephalins.

Beyond diet and exercise, the body requires consistent restorative sleep to repair, rebuild, and restore better function. Shorting yourself on sleep is one of the quickest ways to undermine your overall health, lead to a compromised immune system, stall injury recovery, and amplify pain. I have a program that we teach patients to improve sleep, sometimes using natural sleep aids short-term to shift the body back into a healthy sleep cycle.

Finding productive outlets for stress, and finding a supportive social network of friends and family is essential. Stress levels are at an all time high for many of the patients I care for in my practice, and the stress for many can feel unrelenting and overwhelming in our fast-paced society. Persistent unchecked stress can have detrimental results on health and function. This can be compounded by the fact that many patients are not surrounded by a supportive network of people each day, whether at work or home. My staff and I have devised multiple ways to be that missing support system for our patients through our clinic interactions, phone calls, email, or social media.

Q-Is the root cause of pain from lifestyle/work complications or are there genetic factors that can affect this too?

In my experience, I see a combination of factors that contribute to pain. Rarely is it a single factor. While it is true that there are some conditions where the nature, or genetic factors, can contribute, the nurture, or lifestyle factors, will almost always have a greater impact on the magnitude and effects of the pain for the individual. You cannot change your genetic makeup, but you do have a significant amount of control over whether or not the genes will be expressed. The how, or if, certain "negative" genes will be expressed is directly impacted by your overall health and lifestyle, or environment, that you expose the genes to on a daily basis. There is good evidence to support this.

If you eat poorly, never exercise, hardly sleep, have stress levels through the roof, and have nobody to lean on, this certainly is going to make you feel worse if you are suffering from pain. It may also lead to the expression of the "negative genes." If you eat healthy, exercise regularly, sleep well, have productive outlets for your stress, and have loving, supportive people around you, then it is much more likely that the "negative genes" will not be expressed - or at least have far less potential to be expressed.

Q-What is "Medical Fitness?"

Your level of fitness is vitally important to your overall health and function. It is important to understand the role of fitness in your daily routine and the effects it can have on the life you want to live. There is a perception in the United States, that as we grow older we lose strength, function, and overall vitality. This can be a self-fulfilling prophecy if you don't do something about it.

Focusing on the whole body, we use science and evidence based tools to create a sustainable life changing approach to your diet and exercise. We teach and educate clients and patients on how to live a healthy lifestyle, exercise appropriately and improve food choices based on your needs.

Whether you are looking for a complete life transformation, to lose weight, function better, increase performance or feel amazing we know with our Medical and Fitness integration you will certainly experience the difference and get the results your desire. We want to help you figure out exactly what you want in your life - an exercise program, nutrition plan or a lifestyle change - and then fit it to your current lifestyle.

Q-What would a typical session look like for a person participating in Medical Fitness? first couple of visits would consist of a review of pertinent medical history to determine the starting point for each client; defining concrete short and long-term goals; functional movement screening; and potentially other tests such as indirect calorimetry (used to determine calorie needs). Our training staff would then work with the patient in a one-on-one or small group setting with the first few visits focused on restoration of functional and fundamental movement patterns needed for everyday life. Each visit builds on the next, with incremental changes to take any patient or client from a starter level all the way through very advanced training for their performance goals.

Q-What is "Functional Medicine?"

Functional Medicine is a broad category of medicine that engages both the patient and practitioner in a therapeutic partnership that seeks to determine and address underlying causes of disease using a systems-oriented approach. Through this partnership and patient-centered care, the patient is empowered to take ownership for their own healing.
It is a progressive approach to the practice of medicine that aims to deliver true health care, rather than masking symptoms and creating "artificial health" with a disease-centered focus of practice reliant upon "a pill for every ill".

Q-What exactly is a plant-based diet? Can this type of diet have an effect on pain management?

Plant-based is exactly what it sounds like. The foundation of the diet is derived from plant sources - vegetables, fruits, and healthy grains. This simplifies the concept rather than trying out what vegetarian or vegan does or doesn't include. If it comes from plants, I want that to be the foundation of a healthy diet.

It has become trendy in recent years to "eat like a caveman". While I'm all for returning to what we ate hundreds of years ago before being bombarded with all of the calorie rich and processed (junk) foods in today's stores, eating pounds of meat per day is not likely what we ate, and it will have some negative ramifications on your health. It is more likely that we were gatherer-hunters, gathering whatever plants, fruits, and vegetables we could find, and yes, consuming meat when it was

I really attempt to simplify this for patients. The healthiest diet is likely one chocked full of vegetables, some fruits, and healthier, whole grains. To consume meat, eggs, or dairy is a personal decision, but is not really necessary to get adequate daily protein. There aren't any Americans I see suffering from protein deficiency. These sources of protein need to be evaluated very carefully for quality, as they can be quite inflammatory depending on the method of production, and they may also contain some "extras" such as antibiotics, hormones, or other contaminants.

Some grains containing gluten can also promote more inflammation (that could promote more pain) as well as trigger other health ailments, so with those I am quite selective. The same goes for dairy products and some other foods, such as soy. I instruct my patients on an elimination/reintroduction protocol with certain foods that may be problematic and/or order formal food allergy testing to look for possible intolerances or sensitivities.

So, yes, I do see that patients who work with a primarily plant-based diet (with very selective consumption of high quality meats or eggs) will have significantly less inflammation and pain.

Q-What caused you to try these approaches in your practice?

While recovering from a personal injury a few years back, I began studying nutrition on a fairly deep level. I obtained a certification in Plant-based Nutrition through T. Colin Campbell's online training course through Cornell. I was searching for the optimal "healing" diet to support my immune system function, enhance recovery, and optimize my overall health. I am convinced that the changes in my diet helped me make tremendous gains in the rehabilitation of my injury, accelerated my recovery, and eliminated the majority of my pain (better than medications had).

In fact, I have since written a book on powerful capacity of our food to promote healing and decrease pain. If all goes well, The Pain Free Diet will hopefully be released by November 2014. With this information, I hope to reach a broader audience to help patients kill pain with food not pills.

Q-When a person comes to you, what are some common lab tests they may undergo as part of their program?

In most cases, patients have already had some basic laboratory tests - CBC (blood count), electrolytes, cholesterol profile, etc. They may also have been to other specialists such as a Rheumatologist and had specific blood tests to look for common rheumatologic conditions that can contribute to pain in the joints, muscles, or spine. If these tests have not been obtained, and are appropriate to the case, I will usually start with some of these standard laboratory tests.

If those tests did not shed light on the patient's condition, then I may move on to other specialty lab tests such as food and environmental allergy and sensitivity testing. These tests are extremely helpful to reveal what foods, food chemicals (such as artificial colorings), or other substances such as molds could be negatively impacting the immune system and causing more elimination. Having this test as a roadmap, allows the patient or client to adjust what they are eating to shift the body back into a better state of healing with less daily inflammation.

I frequently get other specialty tests of adrenal gland function or micronutrient analysis testing. The results are used for fine-tuning all aspects of the body not only for pain reduction and injury recovery, but also for sleep quality, energy, and overall health.

Q-Is there anything else you would like to add?

Yes. Every day I ask patients to not put it off another day. Change happens in an instant. Decide that you want a better life, a more functional life, and a life without the hindrance of daily pain. Then set your priorities in life, find the right team to support you, and go after it until you have the life you want.

If you have been in pain and have tried the "traditional route" with less than satisfactory results, then it is time to look for a better way to treat pain. That is what my staff and I at Rejuv Medical Southwest are working on each day with our patients. We're here to be your team. We can help you Rebuild your body, Restore your health, and Rejuvenate your life.

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