Facilitated
Functional Medicine Stories, Strategies, and Science from The Facility. ||
Get the inside scoop on functional medicine with real patient cases, expert insights, and practical strategies to take charge of your health. Hosted by a functional medicine doctor and nutritionist, Facilitated unpacks lab testing, cutting-edge treatments, and wellness trends—no fluff, just the good stuff. Whether you’re a patient, practitioner, or just health-curious, we’ll help you connect the dots and make functional medicine make sense.
Facilitated
15| Not A Quick Fix: Physical Medicine and Rehabilitation Philosophy with Dr. Matt Weaver
Dr. Mitchell Rasmussen sits down with Dr. Matt Weaver, a physical medicine specialist, to explore approaches to pain management and the evolution of chiropractic care. Matt shares his philosophy on treating the person rather than just the condition, emphasizing how building trust and providing honest guidance leads to better outcomes for patients with musculoskeletal issues.
• Pain doesn't always equal damage – the body can heal tissue while pain persists due to other factors
• Harmful narratives from healthcare providers can create fear and limit recovery through the "nocebo" effect
• The "Goldilocks approach" to rehab finding the right amount of activity that creates adaptation without flare-ups
• Focus on what patients can do rather than what they can't do when recovering from injury
• Building resilience through gradual exposure helps patients return to activities they value
• Proper expectations about recovery timelines (often months, not days) leads to better patient satisfaction
• The ultimate goal of rehab isn't dependency on treatments but developing capacity to self-manage
• Chiropractic care has evolved far beyond its origins, now embracing evidence-based approaches
• Creating personalized care plans based on patient goals rather than standardized protocols
• Conservative care providers should serve as guides through the complex healthcare system
Connect with Dr. Matt at Doc Spitz Performance Clinic in Littleton, CO and on instagram @mattthechiropractor
Want to take the next step with functional medicine? Learn more about our new patient process and lab testing at www.thefacilitydenver.com
For more insights, tips, and behind-the-scenes content, follow us on Instagram @thefacilitydenver
Stay curious, stay proactive, and we’ll catch you next time!
Welcome to Facilitated, where we bring you real stories, strategies and science from the world of functional medicine. I'm Dr Mitchell Rasmussen, a functional medicine practitioner.
Kate:And I'm Kate Daugherty, a certified nutritionist. We are the owners of the Facility, a functional medicine clinic here in Denver, Colorado.
Mitchell:We help people improve their biology and get out of their own way. We help people improve their biology and get out of their own way. In my view, our work is about getting to know the person with the condition much more than it's about understanding which condition the person has. As I always say, diagnose the biology, not the disease.
Kate:On this podcast we break down complex health topics, share real patient cases anonymized, of course and explore cutting-edge wellness strategies so you can make informed decisions about your health. Quick heads up before we dive in this podcast is for education and general information only. We're here to share insights, not to diagnose or treat. So if you're dealing with a health issue, chat with a qualified healthcare provider before making any changes. All right, let's get into it.
Mitchell:All right, Good morning everybody.
Matt:Good morning. I'm excited.
Mitchell:You need to be a little closer to the mic. There we go.
Matt:You ever been on a?
Mitchell:podcast before First time. Yeah, today, kind of flipping the script a little bit, I am actually going to let my old friend and former associate, a guy, that I refer everybody with physical medicine problems to, matt Weaver, thanks for coming in today. Super happy to be here. Yeah, this is an early morning for me.
Matt:Yeah, I know, yeah, I texted Mitchell, you know, we kind of organized this and I was like what's changed? What's the tragedy that's happened in your life that got you here to work at 9am? And he said that he was doing this for me Because you're doing this for us. Yeah, I'm really happy.
Mitchell:One of my goals is to share with the people who listen to us, the people that I trust in the circle of health care, and a lot of people do a lot of things differently. There's a lot of different philosophies, and having people you trust makes your job so much more rewarding One of our kind of evolutions in our practice. When we first opened, we wanted to be a one-stop shop and have everything under one roof as far as metabolic and movement and rehab-focused care and therapy and massage and all of that. But it kind of became a thing that Kate and I realized we didn't really like running a business in that way. What we like to is to practice doing our thing and, um, moving forward from that is it's just been all about relationships with outside providers.
Matt:So yeah, yeah, I think you nailed on the head. I mean, like a huge element of what I see in a great clinician is they. They build trust, they have a great network. You know every good clinician has like a person for someone you know and I think, uh, having that clinical humility to be able to refer out for certain situations is incredibly valuable. Um, and that's what you guys do really well. You know, you kind of foster those relationships and build that network and have your people for certain situations and scenarios, and I think a big piece of that too is like being able to know the person and the patient that you're working with and having multiple different providers, whether it be a physical medicine case, and just knowing that, oh, you know this person's personality, I think would mesh well with this provider's personality, I think is a big piece of, you know, managing conservative healthcare.
Mitchell:So well and the relationship is so important because people care so much more about how they feel around you. And I mean I told you this when I first met you. I said you're awesome, I love your mentality. I like I can tell you have a big heart, we will figure out the technical stuff. If you need help, we will find places for you to be educated more and learn. And because you were just coming right out of chiropractic school fresh yeah, school, you know and it was so fun to watch because you worked with us a year and a half, you know, and just watching your growth, um, was so fun. But like that was my big thing was like I trust you. The moment I meet you, the first time we had a conversation, I need this guy around me. So I I was never worried about the technical stuff because I trusted who you were as a person yeah, and I think it's a mix of both.
Matt:You know you want to have someone that's sharp with the technical skills and I think one thing that I learned and we can get into it later with going through school is that a lot of my philosophy and thinking kind of going through the program was very, you know, I was formed and developed by what I was reading in the literature, in the current literature, and it's like there's so many elements to um, being a conservative healthcare provider where we're not cutting into people, we're not, you know, uh, changing out parts and pieces.
Matt:Uh, and the soft skills, I mean it's like every time that you get into the paper, it's like, you know, being able to listen, being able to uh empathize with people, being able to just be human, and how far that goes from building rapport and creating greater health outcomes for patients is just, I mean, it's amazing, and so I think that was a heavy emphasis for me and I knew that a lot of the hard skills would come later with experience, um, but a lot of the soft skills of just being an empathetic healthcare provider uh just kind of rose to the top in terms of the information that I was, I was, I was reading, so when I think one of the downfalls of the chiropractic field is a lack of a residency after school, and I think it's you people who go out and just start on their own right away.
Mitchell:I think they're missing the ability to play in the sandbox and learn and, like you said, very low risk interventions oftentimes the things we're doing you're telling someone to to brace when they stand up or to, you know, engage their body in a proper way and it's low risk but we still don't really have much perspective coming out of school and I think that was one of the things that I really wanted to help you with, regardless of where you ended up was can you have a place to play and learn and have guidance and have you know people that had experience over top of you? Because I was given that out of school. You know, I worked for a guy who had 25 years of experience and we didn't practice the same way, but I watched how he could diagnose and manage personalities and fear. You know you have a back injury. Your whole world shuts down. What do they say? You've got a thousand problems until you don't have your health. Yeah, yeah.
Mitchell:And I think I saw a great example of that from a former boss and I was like trying to channel that with you, like give you place and, you know, let you kind of figure it out as you go. Yeah, absolutely. So I'm curious like what led you to becoming a chiropractor?
Matt:It's a good question. I would say so. Whenever I was in my undergrad studies, I was playing baseball. That was my main sport and I had a back injury, and I think it's a pretty common experience for most people that get into healthcare is they got sick or hurt and they, you know, met providers along the way that helped them tremendously and then they wanted to fill that role and felt inspired by that and that was very much so my story. I had a family friend that was a chiropractor and you know we can get into it, but there's different kinds of chiropractors, different kinds of providers, and fortunately I was, you know, able to fall into a situation where I had a really helpful chiropractor growing up that helped me through various sports injuries.
Matt:And then it wasn't until I was in college and I had a back injury playing baseball up in Canada, and the team was sponsored by this kind of like, you know, super swanky, really cool looking sports chiropractic. And you know, know, as an 18 year old, I'm like, oh man, that's, that's the dream, that's what I want to do. And so, um, I felt very inspired by those people, looked up to them a lot, and that led into more conversations of, okay, where do these people go to school? What do they do outside of work? What's their quality of life like? Do they enjoy what they do?
Matt:And I would say I spent a lot of time just like cold emailing people, reaching out, shadowing, getting as much experience as I could, uh, just because I'm a big analysis paralysis kind of guy. And so, uh, I wanted to be very certain about the path that I was taking and, uh, it was pretty interesting. When I was early in my undergrad and kind of, you know, dipping my toes into the profession, I had an internship at a chiropractic clinic that basically my big takeaway from that was this is exactly what I do not want to do, and it kind of inspired me to, you know, go into more of an evidence-based practice and kind of silo myself into an environment where I could make a change within the profession for the better, hopefully, um. And so that was pretty much my whole experience and inspiration into getting into it.
Mitchell:So what were you? What were you seeing that you didn't like? Cause I bet it was similar to what a lot of us that are trying to push the profession forward experienced.
Matt:Yeah, yeah, there's an element of being a chiropractor. It's like, especially in social settings, you know, everybody has a story and a lot of the times it's pretty classic, you know. It's like I'm at a two-year-old's birthday and I meet someone and they're like oh, you're a chiropractor. I went to a chiropractor once and, uh, you know, they took a bunch of x-rays in my spine, told me that all these things were wrong with me, signed me up for a care plan for six months that costs $7,000. And and it w, it was a similar environment to that. And, uh, you know, I was very fortunate enough in the moment as, like a very young, impressionable guy, to have the awareness of like, wow, something is wrong here. This is not right, you know it's.
Matt:It's very emotive, it's very emotionally driven, very salesy, um fear driven very fear driven yeah yeah, exactly, um, and so, uh, having that experience, I think, motivated me so much more to just be the opposite of that, you know, and so that was really helpful labels can be harmful, right, and it's in school, in any medical field.
Mitchell:We're taught, and it's hard from one side because we are taught to ask what's wrong, how bad is it? What makes it worse? You know what set this on? And sometimes there's so much of a focus on what's not going well. Right, and what I noticed, I mean early on, when I sent someone to you with a pretty complicated elbow issue and you, I asked you for a diagnosis or what you want, and you're just like you know I think they're not gripping. Well, I mean, I don't remember exactly how you said it, but you were very vague and I remember I was trying to push you, but then I like reflected on that, like, well, actually what you're trying to do is figure out what we can do about it. You know, we see that this hurts and it's been hurting and you've had a diagnosis, but has that gotten you anywhere? And I learned that from you actually was sometimes focus more on what we can do in a path forward and graded exposure and things like that, and less on what the name of the thing is yeah, yeah, and I think that's important.
Matt:You know, it's like you guys talk all the time, it's like you're working with the person in front of you, not the condition they have. Uh, and I think the same applies within musculoskeletal healthcare. It's like, you know, so many people come to me, uh, with experience with previous providers talking about what condition, what problem, what they said the solution was for said condition. And you know, I appreciate those things and I'm able to, you know, recognize them, but I try not to put too much of an emphasis on it or a focus, just because things are complicated. People are complicated and you know, I think a lot of the times if we can simplify things and just break it down to the basics, we can make baby steps forward without getting lost in the weeds. So what would you?
Mitchell:say, your principal kind of clinical philosophy is I. I, when I send people to you, I typically say he's gonna listen, he's very nice, he's got a lot of the hands-on skills, because I know you, you needle and you do soft tissue work. But I really look at you as a guy who's a, a plan maker, where you can you develop the, what you can do between visits and strategies like that. So like what would you say? Like how do you describe your philosophy to someone who's just meeting you, not at a two-year-old's birthday party, but yeah?
Mitchell:say someone, you know, hey, my neck hurts. Like how would you do it differently or how do you approach this?
Matt:Yeah, I think a lot of the times people want to understand a reason as to why they're in pain. And you know big things that I talk about with folks, especially if we've got like some sort of chronic reoccurring issue. There's not like a, you know, traumatic injury or anything like that. You know it's like we're talking about the four pillars basically of you know, sleep, nutrition, stress and physical activity, and you know it's kind of like we want to find the perfect pattern or dosage of these things and be able to implement them. Well, I think you know, taking a step back, you know a lot of people try to put the carriage in front of the horse. Let's say, you know a lot of people try to put the carriage in front of the horse. Let's say so like. A good example is like you know I've got, I've got someone coming in and they've got, you know, knee pain. They just went for a hike. They haven't gone on a hike in you know, six months because it's been through winter.
Matt:They did no kind of resistance training or strength training through the winter and then they jump into this activity where they're spending a lot of time on their feet for six hours on end on a pretty aggressive hike and then they get knee pain and they're really confused why they have knee pain and I think you know they talk about, you know, patellar instability and VMO firing and all of these things my glutes aren't working or my glutes are turned off and I think what I feel like I do well is just creating a plan and communicating to these people that, you know, day to day, we're just training for the activities that we want to be able to perform, whether you're, you know, 75 year old grandma that wants to like, get your coffee mug out of the cabinet, or if you're an elite athlete that wants to perform the best of their skill or their task, perform the best at their, their, their skill or their task, uh, and so I would say we want to make the really simple and effective things big, and maybe, you know, we can get into the weeds a little bit once we've kind of, you know, put the horse in front of the carriage and we're doing the right things, right, uh, then we can talk about the minor percentage points you know of of, okay, um, how is my knee tracking, you know, when I'm doing a certain exercise of this movement.
Matt:But I would say, like, big thing in my philosophy is like let's try to simplify things, you know, let's, let's, let's control the things that we can control and make minor efforts and ultimately create a game plan. I think that's really important. A lot of people you know, especially in our world when we're in a fee for service kind of profession, you know they want results. In the moment and I think a lot of the times within our field, if we're not laying hands on people, we're just not being effective and doing the right thing. And I think that was a big insecurity that I had to get over getting out of school is that you know there's a lot of value that we can provide in terms of just creating a plan for someone, listening to them, giving a direction and a guidance and things that they can be doing outside of just you know the 45 minutes that I get with someone.
Mitchell:Well, I love that you are actually in a place that you can actually provide that much time, which is quite unique in our field, super unique.
Matt:Yeah, yeah, and it's not the fault of the providers.
Matt:A lot of the times it's like you know, at the end of the day, we're all human, we have families, we have responsibilities, we have bills to pay, and so whenever people get out of school, you know it's kind of a grind where they have to, you know, meet quotas, see a certain amount of people. We have a lot of student debt and things like that that you have to take into account as well, and so I feel very fortunate that I'm in a space where I can spend time with people and do the things that I think are effective and still doing the hands-on therapies, like the dry needling, the soft tissue work. I think a lot of it is just the classic saying is tools in your tool belt? There's a time and a place for these things, where you know I think it's really important if we can you know if I can change your experience and how you're experiencing that pain to that certain tissue, even if it is temporary, like I'm not communicating to people that hey, you know, if I adjust your C2, you know that's going to fix all of your problems.
Matt:Um, I think it's important that if there are therapies and modalities that we can use to temporarily dampen that pain so that we can get to the real work. That's that's really valuable. I think there is. There is, um, some good that can come from that.
Mitchell:I think what comes up for me is the idea that a lot of people get injured or get pain because they've done too much too soon for too long. That's what you're describing. Like you go from the couch to six-hour hike and now you think it's your patellar instability, when really you don't have any endurance and tension in those tissues properly. I had an old professor. He said you know, in the field of functional medicines we're so focused on this idea about root cause and why and this and that, but at the end of the day and the example he said to me was if you had someone drive by your house and throw a brick through your window, and you grab the brick and you chase them down and you found who did it aha, I found you. Your window is still broken, did it? Aha, I found you. Your window is still broken.
Mitchell:You know and he's in really shift the focus to the biology and to the psychology of the person If you can connect with them and help them see that sometimes pieces just need to be put back together instead of focusing so much on oh, you know, your low back hurts because your glute got weak which, by the way, if you're standing, I don't think your glutes are weak which, by the way, if you're standing, I don't think your glutes are weak or you know when we hear this a lot with people that mean, well, probably, but they'll say your abs are weak, and I've asked people that have said that to individuals. How are you testing that? What is the parameter that tells you that the abs are weak?
Mitchell:yeah you know, and I think that those can be kind of actually harmful narratives and you know I spent years doing, you know, functional movement and all this and that, and it's convoluted, it's complicated, and actually it was when you worked with us realizing that sometimes, like you said, the basics need to be strong before you worry about simple things like knee tracking.
Matt:Totally. And, and you know, just being human, it is almost a guarantee that we're going to have a situation in our life where we do too much too soon, or we get something that we're not quite prepared for, or it's unexpected. That's just the stressors of life, Right, Um? And I think we can recognize those moments. But I think a big piece is that we want to, you know, train and build ourselves up to make us most resilient to those stressors, and that just helps us moving forward. I think that there is, you know, nothing that we can do to absolutely prevent injury or pain. That is just an element of being human. But, you know, we can try as hard as we can to make ourselves most resilient, to improve our quality of life. So whenever those things do happen, it doesn't just totally throw us off the rocker and kind of uplift our lives and it's something that we can kind of bounce back from.
Mitchell:There's so many parallels to what I do from a, from a nutritional biochemistry or systems biology approach, because that's what I say. I get a lot of people with chronic infections and you know, immune system dysfunction. They're getting sick all the time and for you if, if that's what you have going on, my goal is for you to not never get sick. You're going to be on airplanes and be in crowds and things. My goal is for you to not get get sick. You're going to be on airplanes and be in crowds and things. My goal is for you to not get every sickness that goes around and, for the times that you do, to have enough barrier integrity and you know, natural immune system responses so that you can get over them more swiftly, because, again, there's no way to avoid it.
Matt:Yeah, yeah, there's a uh, uh, an analogy that I use very often, which you've probably heard, about the kind of cup and the liquid that you're putting in the cup as stressors.
Matt:If you want to imagine that we have, you know, whether it be from a functional medicine perspective and immunology or physical medicine, in my realm of, like pain and rehab, it's like we have a finite capacity of stress and things that we can withstand of stress and, you know, things that we can withstand.
Matt:And whenever that capacity or that cup overflows with a lot of those stressors, that's when we start to experience symptoms and pain and discomfort or dysfunction from a from a biologic perspective. And I think you know we got a couple options. We can either, you know, build a bigger cup, you know, make ourselves more resilient to be able to withstand more load and more stress, or we can take some of those things out of the cup, you know, try and find, you know, lifestyle changes or things that we can do from a day to day basis that just kind of limit the amount of stressors temporarily, so that we can create a space to build a bigger cup. Build a bigger cup and I think that applies to you know a lot of things that helps us simplify just how we view our biology and how we approach a lot of these kind of you know, because everyone that we're working with they're recovering from something right, and so we're meeting people when they're kind of the cup is overflowed, it's exceeded, and so a lot of the times people are very confused, they're very vulnerable and they just need someone to be very honest and listen to them and be able to create an adequate game plan for them.
Mitchell:What do you when you think about pain? Do you see any common mistakes that people make right away, like it was like a first line, like, oh, you just kind of either made it worse or maybe took steps back. Like what do you think are some of the things that people, I guess you might say, mess up early on in the pain cycle?
Matt:yeah, that's a great question, I think. I think it differs if we're talking about acute, subacute or chronic pain. Uh, you know, if we have like a certain traumatic injury, you know, um, like if I've got an athlete that you you know was doing a plyometric exercise, cut back really quick, tweak their Achilles, you know, and had like a minor rupture, that's a very obvious situation where, like, we have a mechanism to understand OK, this is a validated pain experience. There is tissue injury but there are different kinds of pain. You know, it's like we have nocebic pain, which is kind of like from a neurologic perspective, it's like when I touch a burning stove and I get that feedback. That's a very quick pain experience that, you know, protects me. It's an evolutionary biology.
Matt:Over time a lot of that pain gets muddled. We get a lot of these kind of slow type of pains that are more with chronic pain, and I think a big mistake that people make is that pain equals damage, and that's not always the case. A lot of the times, especially what we see from the literature is, you know, a lot of people have damage but don't experience pain. A lot of people have pain and don't experience damage, and so that's where it gets very convoluted and difficult to work with, just because, you know we're not treating the pain specifically but we're trying to understand that person's experience, and it gets very complicated because your experience of pain is going to be very different than my experience of pain and vice versa. And so I think it's just important to meet people where they're at. And a lot of the times I'm communicating to folks like okay, we've got this chronic thing you know, maybe we had a tissue injury two or three years ago from you know, some sort of traumatic experience. The body's pretty good at healing itself, and so a lot of the times, what we'll see is that tissue is healed but we still get pain in that area, and a lot of that has to do with, you know, previous advice that these people have been given by other providers.
Matt:One thing that I want to talk about is, you know, I think we're all familiar with placebo. That's something that we experience within healthcare of. You know, you get the red pill and you get the blue pill. The blue pill is fake, the red pill is real, but people experience good results from the blue pill. Right On the flip side, there's such thing as called nocebo, which is basically, you know, harmful narratives or communication tactics that I can use that would make you fear, avoidant and increase your pain experience, like you know, if you had a back injury.
Matt:And great example, actually I just had a patient last week, older gal, she just had a spinal fusion surgery, she's been um going to PT recovering and she saw a young, young physical therapist and, um, I, I mean I can appreciate the story. In this situation I would have done the same thing and I probably still would do the same thing. Um, and I appreciate it because she's doing uh, she's in rehab, she's about three months post surgery and this young PT had her doing free weight, farmer's carries, just walking up and down the turf and I was like awesome, that's great, that sounds great. Uh, and unfortunately, this patient of mine had a really bad flare up and low back pain, uh, and then she went to her surgeon.
Matt:The surgeon said you should never do free weights after having a surgery like this.
Matt:And I mean how much?
Matt:How does that affect you psychologically?
Matt:When it says I should never do free weights, that means I should never, you know, pick up my grandkids.
Matt:I should never, you know, carry my groceries from the car to my house and it creates this kind of fragility where we get fear, avoidant of certain behaviors, and what we see in the literature is that can kind of amplify our chronic pain response, make us a little bit more timid and shy around things. And so I think what I advocate for greatly is, you know, the devil's in the dosage. We don't want to do too much too soon, but we want to slowly trickle in really difficult things that people would be, you know, afraid of doing, and then get small wins, just build up that confidence over a long period of time. I think that is just really important and it's it's just sad that we still, you know, in our modern era of musculoskeletal pain uh, I hear narratives like that daily all the time Um, and and I think like a big effort of how I communicate is to, uh, hopefully make advancements to building up resiliency and empowering people, as opposed to creating some of those nocebic languages.
Mitchell:Yeah, I'm. How can you live if you can't? You know, and it is, it's interesting people create, uh, they become a shell of themselves. They're all essentially casted in space where they're afraid to bend and twist and move and and all these things.
Mitchell:Um those narratives, yeah, they can be incredibly painful to experience you know you mentioned like at a birthday party, telling someone you're a chiropractor. What I experience is either someone people love you like oh, because I don't do any sort of hands-on work, I'm strictly in the functional medicine, immunology world. But you tell someone you're a chiropractor and it's either oh, my gosh, my neck hurts, can you work on it? Or an eye roll and a self-judgment. I mean, what are some of the misconceptions about the field that you wish people understood a little bit better?
Matt:Yeah, it's very polarizing, right. Um, I think I've had plenty of those experiences and I mean I'll, I'll. I'll be quick to say I think there's elements to health and healing that I think we'll never really understand. You know, it's like you hear stories of people seeing like an Atlas orthogonal chiropractor that had, you know, chronic migraines and immune dysfunction, lyme's disease, and then they saw this chiropractor that adjusted their C1 with a crazy device and everything was better and cured. And so I just kind of sit back in those moments and I say, wow, that's amazing, good for you, that's really cool. And I think early on I would have been like no, no, no, no no.
Matt:That doesn't work that way, and I think I've just been able to step back and appreciate that there are elements to health and healing that we just won't understand, and people get better for reasons that we don't understand. And you're right. It is very polarizing and it's like you either get a response of like, oh my gosh, I love chiropractors. You know, I've been seeing chiropractors my whole life, since I was a baby and then you have on the flip side people that are like oh, you know, you're a quack, that's pseudoscience. You know, I don't, I don't adhere to that, and it's. It is pretty interesting.
Mitchell:Well, online, a lot of people will say you know, that was started with a fraudulent magnetic healer and all this stuff. And number number one, our field has evolved so far beyond this. I mean, look at what you do, look at what I do. That has. What you do has very little to do with the hands-on work and much more to do with the structure and the systems that you're placing into people's lives for for control, and for me, as someone who doesn't do any of that, it's like look when that magnetic healer was allegedly, you know, seancing or whatever medicine was putting leeches on people yeah, you know. So what if we go back and say, well, that field was started with potions and leeches on people?
Mitchell:yeah and then that's where we stopped our thinking and that's what frustrates me. So much is like I understand fields evolve, they get better as science gets better and essentially, people are trying to feel more safe in their bodies totally, and we have gone so much further than a seance, whatever magnetic healer, to now seeing the the role as conservative providers we can give to people. When I look at a patient, I think about four pillars of clinical decision making. I've got the presenting illness. I've got the history and the family history. I've got results of biochemical tests whether it be stool tests or mold tests, depending on what the history shows and then I have responses to low-risk interventions. If I'm telling you to chew your food more and to be more present with your meal, there's not a risk there.
Mitchell:I guess you could chip a tooth right, but it's like I'm seeing that you've got a profound methylation issue and I give you nutrients and diet changes to support that process better.
Mitchell:The system will only get better and it's. You know, we've moved so far beyond our origins as a field and I think that's a blessing in our field where there are so many approaches and there's a big umbrella. But I also think it's it's hurting the field from moving forward because there's no alignment we still have. We graduated with people that are still preaching spinal alignment and bones out of place in this idea, and I think it makes our jobs a little tougher. Because, yes, I am a chiropractor, but let me show you how I view things. I'm getting to the point now where you know I'm, and you're probably, pretty much referral based, so it's less of having to sell what you do to people, right, and and that's been a big change you know being doing this for about the last decade is I'm finally at a place where I don't feel the need to explain how good I can help you or something like that, because you're already coming in.
Mitchell:when your friend or your family member said these people have a really cool approach, they will listen. Oh my gosh, how many times in the intake. That's the number one goal is I want to be listened to and we will be open to the chance that maybe your body does want to heal.
Matt:And if we can remove some impediments and support some things that aren't working, things will start to fall into place and, as you said, get some small wins and those small wins add up for sure and I and I think a big piece of why you know fields like chiropractic, you know, blew up in the way that it did was just because you know there's something inherently human about just wanting instant gratification or a quick fix for something. And you know certain things will fill that void of you know providing a quick fix. And you know, kind of going back to what you were talking about of like maybe common misconceptions about pain or chiropractic or musculoskeletal care or even healthcare in general, um, is that you know we want a quick fix for things. It's like um, you know, when I have strep throat and I go and get antibiotics, that's a quick fix. It's pretty amazing, you know, it's very effective.
Matt:Uh, but you know, when we're talking about, you know, like a degenerative rotator cuff tear that this person has been developing for the last, you know, 10 to 15 years and they're in a lot of pain. You know a lot of the times what I'm communicating to folks is like look, I'm sure that you've heard stories of people getting really quick fixes from things and that's what makes pain so complicated. But I want to tell you that I'm here to partner with you and that I'll be with you every step of the way, but there's probably not a quick fix and, and I think a lot of the times, um, honesty can kind of deter people and turn them away, um, just because you know they want that, that, that confident and assertive decision-making that like, hey, we're going to, we're going to fix this really quickly. Uh, and a lot of the times that's, that's just not really the case. Yeah.
Mitchell:I typically and it used to be an insecurity, and now I think it's something I can really hang my hat on is, if you want relief in the next 15 minutes, I am not your guy. I won't give you a cortisone injection or you know some sort of magic neurological thing that will make you feel better right now. But if you give yourself a couple of months and you really are open to change, I know I can help you to what degree. Well, you're going to show me and, and my goal and I think it's kind of what you're saying is I want it to be me and you partnering against your issues, not me against you, because you know we have.
Mitchell:I've had plenty of experiences where, because of the person being in such a state for so long, it becomes almost antagonistic from the get-go and I struggle with those people because it almost feels like you're placing yourself against me. And one of my goals early on is to help connect with somebody and help them realize I'm. I'm in this with you. Like I've had 10 surgeries. I've dealt with anxiety and unmitigated ADHD.
Mitchell:Anybody listening to this knows probably that I have some you know attention deficit issues, but what I've realized is finding something I love that I can hyper focus on, like systems, biology has given it's almost a superpower, but I digress is given it's almost a superpower, but I digress. I think the more we can help align with the person and their issues they're having, they can realize that we're just both people and I'm here to be humble. I'm here to be open to what might change and I'm here to give you guidance on the easy things that you can clear out today totally from what you're doing yeah, and I think that's huge just early on setting precedent of of expectations.
Matt:You know when you yeah, and I think that's huge just early on setting precedent of of expectations. You know when you first meet someone, I think, like you know what I think you guys do really well, um and uh, what I think that we're aligned on is just with that initial evaluation of meeting someone, of making a good first impression and setting expectations for expectations for care, just because a lot of the times, people come in with preconceived notions you know previous narratives, things like that and so we just want to get on the same page and communicate effectively and efficiently. You know a plan of care where they're at now, maybe talk about some of the narratives that we can kind of, you know, suss out and maybe break down and challenge a little bit, uh and and hopefully create you know, a path moving forward that seems clear, concise and hopefully effective. Yeah.
Mitchell:It took me many years to be able to look someone in the eyes and say I think this is going to take six to 12 months six to nine months because there was that idea Like I want to provide you hope and clarity right away, but I realized that selling someone this idea that a month from now, you've been dealing with this for 12 years, a month from now, I'm not sure how much is going to be different. What I hope is your hard days get a little less frequent, your easy days become more common and the time between them is not so rough. But look, there's a lot going on here. You, like you said, you've been fed harmful narratives. You've had a lot of time in this state. Your biology resists change. Yeah, it is going to take time and I think stepping into that expertise, I guess of just looking someone in the eyes and telling them I think this is going to be. You've got a road ahead of you, but I will help pave it with you Totally.
Matt:And I think we're in a good space with the just body of scientific literature that we have, just body of scientific literature that we have, like you know, when I think about low back pain, for example, and you know we kind of triage that diagnostic process and we deem that this is like a non-specific low back pain case. You know we don't have any radicular pain. You know there's not any kind of lesion or, you know, arthritic condition, nothing that's going to complicate things further. You know, within the literature for certain conditions we have these things called natural histories. You know, which is? This is the amount of time that we see generally for these conditions to get better, and time is a really good healer for a lot of things.
Matt:And the unfortunate reality is when I look at someone with a very acute low back pain flare up that is nonspecific, without any sort of you know red flags or you know signs or symptoms or from my exam, that I deem as, like you know, this is a surgical case or this is refer out to pain management. You know it's hard to look these people in the face and say, hey, you know, this acute low back pain that is just ruining your life, that's preventing you from being able to do really anything. What we see in the literature is that these things resolve on their own within three to six weeks and on my side of things, not being able to experience what they're experiencing in that moment, that's easy for me to say, but for them in the moment, three to six weeks is like an eternity. That is a really difficult thing. To look someone in the eyes, three to six weeks is like an eternity. You know that is a really difficult thing to look someone in the eyes and tell them, and so I think I always caveat that with you know, we have these natural histories for these certain conditions.
Matt:My goal and my effort is to make that process as seamless and less painful as possible and give you the tools that you can, you can use to manage this on your own. Uh, and you know, do whatever I can do in terms of guiding that, that plan of care, um, uh, but it's, it's really tough. You know these people are in a lot of pain. You have to, you have to tie your shoes and get off the toilet.
Matt:Yeah, you have to do, you have to go to work. You know you're a single mom with, uh, with a lot of kids, and you're working two jobs and you can't just, like you know, hit the pause button on life and and that's really tough for for a lot of those scenarios- yeah, what do you think thinking about rehab when these acute or subacute pain things?
Mitchell:what is the role there of movement as it relates to whether it be nervous system, you know, calming or like? How do you see it? Do you see it as a slow exposure or more of a durability and resilience piece? Because your focus very much is on what you can do outside of the clinic, right?
Matt:So like how do you view that and the level of importance that you give that time that people can spend doing rehab and yeah, yeah, that time that people can spend doing rehab and yeah, yeah, and, and I think just from personal experience, let's say, uh, so recently I had like a really bad calf strain and I was training for this long run and, uh, you know, innately in my mind I was thinking of all the things that I can't do. And and one thing that you said really well, there is like what can you do? And I think that is a huge shift in the focus of okay, what are the things that I can't do? And one thing that you said really well, there is like what can you do? And I think that is a huge shift in the focus of okay, what are the things that I can do and can control? And you know words that I throw around very often is, you know, gradual exposure.
Matt:You know we just want to dip our toes in the water and continually increase some of the stressors that we're putting through that low back. And a big analogy that I use all the time is Goldilocks. Everybody knows the story of Goldilocks, right? You know, too soft, too firm, and when we're talking about pain and rehab, we want to find that Goldilocks exposure of rehab and movement and physical exercise. You know enough to where we're able to create an adaptation, but not too much to where we flare up some of the symptoms and irritate that pain response further. And so you know the classic things with like an acute low back pain is. Like you know, I'll see someone that's been doing McGill three for the last three years for their chronic low back pain and have not quite transitioned into more of like functional movements to kind of increase some of the stressors to create adaptations and improve the functionality of that individual.
Mitchell:Well, the end of rehab is strength training right, Totally yeah.
Matt:Yeah, yeah, and it looks different for everyone, right? That's wanting to compete in their first hundred mile or three months from now versus you know, someone that just wants to live without pain and improve their function and be able to sleep well at night. Those are very different plans of care, and so I think it's important to you know, recognize the person in front of you, and I think the greatest question that you can ask is you know, what are your goals, what are you looking for? And that totally dictates your plan of care and how you want to manage things.
Mitchell:I love that. Is there a tool that you keep finding yourself leaning on that you wish more people would utilize?
Matt:That's a good question. I send out a lot of resources. You know I've built a low back pain guide.
Mitchell:Yeah, we still send it helpful. We still send it to people.
Matt:I use it a lot for my patients, just because it's kind of like a self-help tool and self-guided for people to kind of work through. Uh, I, I lean on that heavily. I, you know, I lean on a lot of, you know, sports specific training type tools, um, and you know, ultimately it's about figuring out you know what kind of access these people have to equipment, um, and going back to just their goals and what they have, and so I don't have anything like super specific that I really lean on there, um, but education the education is huge, yeah, yeah, and I think just being able to, you know, continuously talk people off the ledge and kind of put just psychologically people at ease, yeah, Well, and I think you and I are both in the business of not wanting to see people very often.
Mitchell:It's funny, we fly in the face, like any business teacher would hate our strategies, but it's because of our heart, yeah, it's because we number one. Most people don't have time to be able to come in, to be able to come in all the time, and it's a financial thing and it's funny that we both approach so differently, but the heart is so similar, the the philosophy of I want you living your life. I want to be. I always tell people I want to be a mirror for you. I want to listen and hold up a mirror so that you can see yourself the way that I see you, and that we can slowly start to change what that looks like, whether that be a mold issue or a chronic Epstein-Barr virus reactivation or whatever that is. I'm trying to let you see it. Give you tools, send you literature, send you podcasts we make, send you blogs we write, so that you maybe only have to see me a few times a year because it gets expensive, but you can now take those tools and run with them For sure.
Mitchell:It's funny because we're not taught. It's not a great business strategy, but it's like I look at it as someday I will hopefully live to a ripe old age and I'll have to consider what I did in my life and my life's work and my purpose, and the last thing I ever want to feel in those later years is that I took advantage of people or that I was so personally successful. It is so much more about what we call the ripple effect that I can impact my community and let them go on to change their environment and their world and their people and their life, but what that means is it takes a lot longer to grow from a financial and business perspective.
Matt:Yeah, yeah, absolutely. And I think you know something that we probably struggle with a lot is just figuring out what the minimally effective dosage is for that certain individual. I think early on, you know, I, I, I leaned far um on the spectrum of you know, okay, I get this person with an acute flare up of pain, um, and, and reading people is really important in terms of you know kind of where they're at, in terms of you know how they think about their pain, how they think about their recovery, how much it's affecting their life, and you know, and I would be like, okay, let's follow up in two weeks.
Mitchell:I remember this.
Matt:And two weeks from now, it's like I see this person and they've just totally spiraled, you know, haven't done anything about what we had talked about and communicated, you know, become more fear avoidant, sought out other help, seen other providers, and it just further complicates things. And so I think a big piece of what we're trying to do is figure out, okay, what is the least amount that I can intervene while still being effective. And I think that you can go either way with those things of intervening and uh, creating interventions that are too often and too much, too soon, uh, and then, on the flip side, you know, having follow-ups and and and being too uh passive with how you want to intervene with people that can be equally as damaging on either end.
Mitchell:Well, like you said, time is a great healer. I think when you started or I know, when you started working with me, I think it took you a little bit to realize that I'm purely approaching it from outcomes, not from this is what you're billing. I don't know if we ever talked about this is what you're billing, matt. It's about effectiveness, right. And I think once you realize that that's where my heart is, you were willing when I said, like look, this person has an acute bicep tear. You should see them in four days. You might not see them, you know, in a month you might see them once a month, but right now they need you, they need what we call those touch points. And I think it just took some time for you to kind of get out of your head Like I don't want to be that schemey chiropractor, and you realize like well, shoot, there is a certain dose that they are going to need to lean on somebody early on until they get they can pull the training wheels off, so to speak.
Mitchell:And I've seen that growth in you. It comes from confidence and from knowing that you're doing the right thing. You know, and I had an old boss that said it's never the wrong thing to do the right thing, and what that means to me is sometimes right away. I'm asking you to make five or six changes. I should expect that at least half of those haven't been done. So why let you go for a month and a half if there's an intervention that I could provide a few weeks in where we can recalibrate and refocus and reinvigorate, essentially so that the person is reminded all the res, so they're reminded of the little changes that it's going to take totally. So I think that's where you're really figuring it out.
Matt:I mean, it takes time, totally, yeah yeah, and and again, I think there's just a huge psychological component of being able to, you know, read the person in front of you and understand. You know how much accountability they need. You know, uh, what kind of reassurance they need. You know how much you want to be involved there.
Matt:There are some people that I work with where I'm like, okay, here's these things I'll see in a month, okay, and and I know that they're going to be adamant about doing those things, uh, and you know, I'll check up in a month and they'll be like, hey, you know, I've done all these things, I'm feeling much better, things are going well. And then there's other people where it's like, you know, I'll schedule them, you know, a week out from seeing them. And you know, again, it kind of goes back to that spiraling narrative of where, you know, the train just totally fell off the tracks and it's like, okay, well, let's shorten things up a little bit. Um, let's kind of stay on top of these things here. And and, uh, we'll kind of be a little bit more strict with how we're guiding some of that care.
Mitchell:Yeah, it's it's. I might have the best plan for you, but if it's convoluted and overwhelming it's not a good plan. You know, I I have an old friend. He said, uh, a $1 t-shirt that you never wear was a waste of money. It's like the cheapest thing, the easiest thing, but if you never utilize it it was a waste.
Mitchell:So I think about that. Where it is, it's finding that sweet spot and it's about. To me, it's not my goal, it's not my life, so it's not my set of goals. That's the most important. It's what do you want out of this goal? It's not my, it's not my life, so it's not my set of goals. That's the most important. It's what do you want out of this? And then I think my job is to craft solutions for you to get what you want, because I in my head I have a picture of you know the immune system as best as I can, and how hormones influence immune function, all these things, and I might have this idea about where they need to get, but that's that is so far up in the sky for these people, and so it's about coming down to what they can digest and absorb and integrate into their own lives.
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Mitchell:What do you wish? You know, because I obviously send you a lot of people and this is going to be a podcast that I will start sending people to help see why I love you and why I send so many people to you. What's something that you want people to know before they come in to see you as a client?
Matt:Yeah, I think that's a great question. No-transcript can get you know the most effective results. All the while, you know kind of thinking that minimally effective dosage in the back of my mind of you know, I don't want to make just a really immediate and quick referral to someone to another provider. That is just pain management. That's just going to kind of get them into a deeper hole in terms of time and financial investment. And so I think what I want people to hear and understand is that you know, if they just want a really honest opinion, a game plan and, you know, something that will just get them started on the process and be able to help them navigate the health model, because it's very confusing.
Matt:You know it's like. You know it's like people get pain and they're like, okay, I have back pain, do I go to urgent care, do I go to the emergency department? Do I go to my naturopath, do I go to my massage therapist, do I go to my chiropractor, do I go to my PT? And it's like you can see 10 different providers and get 10 different reasons as to why you're experiencing that pain, with 10 different plans of care, and so it just gets very confusing. And so what I would like people to understand and the hope with seeing me is that I would help simplify things and kind of guide that care in that process.
Mitchell:Yeah, I think that's one of the coolest things in Colorado about being a chiropractor is, you know I'm out of network. I don't take any insurance I know your clinic is your spinal specialist, I think and can accept insurance, but we are able to refer directly to neurologists and cardiologists without having to send people to Kaiser or whatever, and I think that being a quarterback on the case is one of my favorite things. I just sent a lady with a pretty complicated myalgic issue. She had, you know, a loose diagnosis in the past of Lyme disease and you know we worked on some things. I wasn't getting where I wanted to go, because I have very high expectations. Especially, her effort was very high.
Mitchell:Sent her to a neurologist and she got diagnosed with a condition, a genetic myalgic condition that six people in Denver have. Wow, it's one in 100,000. The neurologist had never seen it. That's crazy. You know who sees the most complicated issues and now we're sending her to a geneticist and she's going to be getting PT and it just it was interesting to me that that was one of the most rewarding things of last week was simply helping find her the resource she needed to get an answer and then the next time we talked, her entire demeanor changed. You know she had been very frustrated and rightfully so. She'd been working hard and suffering and been to all these providers. But what I did, by just helping find her somebody to get a more clear understanding of the picture, to something that I didn't think was going on, I mean, how would I, would I going to know? Yeah, very complicated, you know, neurologic myalgic, uh, genetic condition and her whole demeanor changed just by helping understand what was going on. And that had nothing to do with the care I provided.
Matt:Yeah, yeah, I think about um. I don't know if you remember this, but it was legitimately probably my first couple days of being with you. I hadn't started as an employee, I was just shadowing and you had a guy come in and he was complaining of kind of abdominal pain you know more in the flank and he was like I've got a strained oblique, you know I've got a muscle strain and you know we're sitting in the room, you're going through the exam, we're going through things and and, uh, you know you're asking him like how have you been feeling? Like you seem kind of like you know, a little bit sweaty, like have you been running a fever at all or uh, and he's like I don't know, I just haven't been feeling great. Just like, you know textbook, you know we're getting pain with this pressure here. You know we're doing a psoas sign, all this stuff, and you stepped out with me and we're looking at each other and we're like I think this guy has appendicitis and we go back in.
Matt:It's not funny at all, but it's just. You know, there's a lot of things that you learn in school, especially as a chiropractor, where you're like I mean, it's good to know these things, but I'll probably never see this. I may see it once in my whole career and I'm in this profession two days and we're making a referral to the ER and this guy had an active appendicitis that was at risk of, you know, creating a bacterial infection and septus, and so that was one of those moments that really humbled me clinically of like, okay, we're in portal of entry providers, we're going to see crazy stuff, and it's important to stay sharp and be able to recognize those things and make it make an accurate referral.
Mitchell:Yeah, I remember I was actually. I felt kind of cool that day because that's not something that we see often. But I I've told myself that you know, we had a lady about a year prior who had appendicitis but her some gas in her bowel blocked it on a CT scan and the ER said there was nothing wrong. So I kind of moved on, even though she had classic symptoms, and ended up having it and I told myself I will never miss this again. And I remember you're there brand new out of school and you watch this.
Mitchell:This lowly chiropractor, you know take in a musculoskeletal patient and then, you know, through exam and history, have the. I mean it takes a certain level of confidence like I'm going to cost you a ton of money, potentially by sending you to the er, yeah, but you know, in that case, yeah, I did feel pretty I got. I was happy that you got to see that right away and I remember your first week you also got to see me work up a guy with acute pancreatitis and you know he came in. I'd given him some oblique extras, like some rolling patterns or something, and he said that it strained his rib and it's the same thing. I entered that conversation, thinking, oh, something I gave him hurt his rib and throughout the 10 minute history you're going to your. Uh, you're going to the er right now because I think you have acute pancreatitis.
Mitchell:And the big one for me was when he doesn't eat he feels better and when he drinks alcohol he gets horrible low back pain and sure enough, I remember that was like dang matt. This is your first week in practice and I think it probably helps set the tone for like, yeah, we are, we are still working up. You know, you see a funny mole on someone. You have to have the confidence to be like. I learned in my dermatology not to diagnose skin things, but what looks a little odd. So I'm gonna send you out. I know it to be a pain. You might have to take off a work and pay a copay or whatever it is, but I'm trained to know what doesn't seem normal and is outside of my scope.
Matt:Yeah, and and I, you know I've, I've made refers, referrals out that you know maybe I shouldn't have, but I feel good about them and I'm glad that I did.
Matt:Uh and you know I've had those patients come back to me and say thank you, like I'm so glad that you did that, just to kind of rule out some of those things. And you know I've made referrals out that I was really glad and you'd get really sad news. You know that it was what you were thinking, that it was Uh, and I think it's important to not have a lowercase g god complex of managing people, that you can fix everything and that you know what everything is, just because that can get you into some real trouble.
Matt:I had an older, 75 year old woman. Thankfully I had been working with her for a little bit and she hadn't seen her in a couple of months. I knew that she had a history of, you know, osteoporosis, osteopenia, and she came in with this new low back pain that was just kind of different, really severe, and I was like let's, let's go ahead and refer you out, we'll get some imaging, um. And sure enough she had like a couple of cracked ribs. She had two broken vertebrae in her spine, um, and suspected kind of metastatic lesions and it's like you know you don't you never want that to be the case?
Matt:Uh, but I think it's important to just be able to recognize the really spooky stuff and make very quick and efficient referrals.
Mitchell:Yeah, you certainly hope you're wrong, but you'd hate to miss it, right? Yeah, I think getting more information, people want it first of all. It first of all like I can't tell you how many times when I order an abdominal ultrasound on someone and they're like, wait, it's 165 dollars. If I just go today to a cash-based center, like why was my pcp not doing this? And it's like, look, that's third-party pain. It's much more complicated.
Mitchell:I can't tell you how fun it is to find to be able to show you your elevated liver enzymes. There's no fatty infiltration, there's no iron deposits. You have high ferritin but there's no iron deposits on your ultrasound. So we can. Or on your mri of your liver. We can move forward now with the confidence, knowing that it isn't something bad. And but I think that is priceless. And it's not about over testing, right, I know you're big on that. Yeah, like those clinics that you know, take x-rays of everybody. And it's like, do you have suspected trauma or pathology? If yes, maybe imaging is important, but if not, let's, like you said, manage it conservatively. Yeah, all right, I, of course I asked you to do this for about a half hour and here we are. I should have known and you have patients in. What about 45 minutes here?
Mitchell:yeah so I need to respect your time and get you out of here, but if there's anything else you want to share, I think big like where can people find you, follow you, reach out to you for care? Obviously anybody who sees me knows how to find you, but you know there's a like, a takeaway or anything else that you want to share.
Matt:Before we cut this, I'd love to hear it yeah, yeah, yeah, yeah, I work over in West Littleton, right on the front range, right on the hog, back at Bowles and C470 in West Denver.
Matt:It's a great space. You know, we do a lot of manual medicine but we are a network with most major insurance carriers, which I think is a great selling point and just kind of lowers the barrier of entry for a lot of people and I do think that we deliver really high value musculoskeletal care and I think that we do a good job within the confines and the restraints that we have. And ultimately, you know, I think it's just helpful to know that there's, you know, providers and referral networks that you can trust and you know people can go into with peace of mind, knowing that, like you know, we're doing the best that we can and we're going to, you know, put our heads together and we're going to care. And so, yeah, you can find me in West Denver and it's at Doc Spitz Performance Clinic and yeah and we'll put contact information in the show notes.
Mitchell:But yeah, I thank you for doing this today yeah, absolutely, it's just a real treat.
Matt:I think it's awesome that you had me on today and I look forward to working with people together. You know we've got a lot of shared patients. It's cool to see the outcomes that we're getting with people, and I really appreciate the work that you and Kate are doing. I'm a huge advocate for you guys and, yeah, I mean it's just the best. I think it's awesome.
Mitchell:Wow, thank you, truly, thank you yeah.
Kate:Love you, buddy.
Mitchell:Love you.
Kate:For more about what we do at the facility, check out our website, wwwthefacilitydenvercom. You can also follow us on Instagram at the Facility Denver for extra tips behind the scenes, fun and updates on new episodes. Thanks for listening. Now go facilitate your own health and we'll see you next time.