Welcome back to the Healing Pain Podcast with Carolyn Dolan, PT, DPT
As you have followed along with each episode of this show, you probably got the feeling that I’m a little bit passionate about how nutrition can be used to treat chronic pain and other chronic diseases. I have had physicians on the show discussing nutrition, health coaches, chiropractors, nurses and physical therapists all talking about how nutrition can impact chronic pain. As I reflect back on these 140 episodes, the one thing we have not discussed is how to treat acute pain using nutrition and physical therapy. We’re going to cover that very topic when we talk with my friend, Dr. Carolyn Dolan. Carolyn is a physical therapist who combines traditional physical therapy with nutrition to treat both acute and chronic pain in her physical therapy practice.
In 2012, Carolyn was experiencing chronic fatigue, chronic pain, chronic sinus infections and was overweight. Her journey to better health letter led her to the world of nutrition and to designing a simple lifestyle program with the profound potential to transform people’s lives. She now shares that in her physical therapy practice. On this episode, you’ll learn how to treat acute pain and inflammation with nutrition and natural alternatives to pain medication using nutrition and supplements. You’ll learn how Carolyn created an innovative and novel supplement for pain that was missing from the marketplace and her key pillars to her lifestyle program for pain and better health. You can learn all about Carolyn by visiting her website, VitaKinetics.com.
If you’re a physical therapist and you’re interested in the how-to of functional nutrition for chronic pain, if you’re curious about which diet is best for pain, whether you’re a ketogenic fan or paleo fan or Mediterranean diet fan. If you just want to know how nutrition can be used to modulate the inflammatory response from the gut-brain connection or the gut joint connection, make sure you hop on over to the Integrative Pain Science Institute and check out the functional nutrition for chronic pain certification. This is a fully approved 36-credit CEU course that I designed specifically for physical therapists and other pain professionals so you can learn the evidence behind nutrition for chronic pain as well as the nuts and bolts of how to use functional nutrition in your practice. The course is open. All you have to do is go to the institute website and click on the Courses tab and check it out. Let’s begin with Dr. Carolyn Dolan.
Watch the episode here:
How To Treat Acute Pain Using Nutrition And Physical Therapy with Carolyn Dolan, PT, DPT
Carolyn, welcome to the show.
Thank you for having me. It’s very exciting to be here.
I’m so excited to have you. We talked about more of the baseline nutritional influences on inflammation. I know you’ve been working on lots of new stuff. You’ve been quite a busy bee doing physical therapy, nutrition, pain, working with athletes and everything. We’re going to talk about treating acute pain in athletes with lifestyle and nutrition. Everything is so exciting because there are PTs out there who are using nutrition, but there are a few of us so I’m excited to dig into the weeds with you. Let’s go way back in time. If you think back to when you graduated PT school, what was the paradigm that you were taught then on how to treat acute pain in an athlete?
The acute pain treatment that I was taught about was NSAIDs, Non-Steroidal Anti-Inflammatory Drugs. It’s to control the inflammatory response and that acute pain state and specific movements. We didn’t talk about lifestyle interventions at all related to nutrition or even sleep and rest. Nor were we taught about how the brain plays a role in your pain response and how important that was even in that acute scenario. Specifically for me being into my clinical practice, this one diagnosis has come up a handful of times and I consider it my canary in the coal mine. They’re relatively rare in the whole scheme of things but in the pain world, they’re not rare. It was a chronic regional pain syndrome. I remember specifically having these few patients where they didn’t fit the presentation I was taught. Sometimes these were incredibly healthy seemingly otherwise healthy individuals who are living active lifestyles and theoretically doing everything right and yet they ended up with this chronic pain condition that just leveled their lives.
I had a mother who was an avid runner, raising two kids and she theoretically had an orthopedic injury and then turned into this chronic regional pain problem. She struggled with her recovery and ended up having surgery. I started to look into that when I went back to school to get my Master’s degree in holistic nutrition. This diagnosis continued to be on my forefront because I felt ill-prepared to not only treat it but how do we prevent it? What I was looking to is how do we set our athletes or active mothers or everyday athletes? What are we missing that sets them up to be at risk for this condition? That’s what catapulted me into that realm. It comes down to how we manage acute inflammation. That’s how I continued and that’s where I did a lot of my research and developed a lifestyle intervention protocol to help with that inflammatory process.
Every ATC and PT and sports medicine physician has heard the acronym RICE. That’s the first thing that people think of when they’re injured and even the late people know about that. What’s your view on that as far as the acute injury phase goes?
It seems to me that in that acute injury phase, we are always looking and trying to find ways to stop the inflammatory process. Even RICE was essentially designed to try and stop the inflammatory process just like the use of Advil Motrin’s non-steroidal anti-inflammatories. We’re trying to stop it. Within my research and understanding the healing process, there was one specific cell that caught my attention and that was the macrophage. Throughout all the healing phases, the macrophage plays an important role even though it changes its role depending on the stage of healing that you’re in. In those acute phases, that first zero to seven days following even a mild injury or a sprained ankle or even that acute stage after following an intense workout where you’re trying to build and strengthen your muscles, you’re inducing an inflammatory response. We then start to throw things at it: compression, reducing the swelling and stopping the pain with the anti-inflammatories and we disrupt the actual process that is there to help us.
When I looked into the chronic regional pain, they’re in this inflammatory state of excess. We don’t want to stop the inflammation because then we can’t heal, but we don’t want too much of it because then we set ourselves up for chronic pain states and autoimmune disorders. There’s this sweet spot within the middle where if we can keep a healthy amount of inflammation, then we can repair, build stronger muscles and reduce our risk for chronic pain states. That’s where I started to look into all those lifestyle components that we weren’t taught about in physical therapy school. We weren’t taught about nutrition and the importance that plays in that inflammatory state, both providing the basic foundation ingredients to heal. We weren’t taught about the importance of sleep.
It’s interesting when you talk about RICE. My favorite part about RICE is the implication of rest because particularly in our athletic population, we don’t allow ourselves any recovery time or rest time. Often, people are just constantly burning the candle at both ends and then more movement and more movement. Sometimes what we need is good sleep. We just need some recovery time or a break where we spend time eating nutritious food and maybe meditating. We need those lifestyle factors that are so important at simply modulating the inflammatory response. They’re not geared towards turning it off. They’re all geared towards keeping it in that optimal healthy range.
Some of the challenges you mentioned here are not unique to PT. In fact, oftentimes patients are seeing multiple different types of physicians before they get to see a physical therapist. The physician hasn’t been trained or schooled in any of the things that you’re talking about and that can be a big barrier in and of itself. Some of this is an education process or the patients are starting to get their education 101 from the physician and then they get to us. There’s a whole other education process that starts to happen. It’s interesting how it trickles down.
Hopefully, the more things that you are doing with this show is getting the information out, not only to other healthcare providers but providing good information to the consumer so they can begin to help direct their care. They can go to their doctors and understand the positive role physical therapy has and say, “I’d like a physical therapy referral.” It’s as much as educating the physicians about our role in this healing process and recovery and prevention, but it might be even more critical at this point. The more we can get this information out to the patient and the consumer so they can start to ask for what it is that they need, but also incorporate some things into their lives as a preventative strategy. It’s about empowerment.
Continuing with that education, what does the consumer need to know about NSAIDs, Non-Steroidal Anti-Inflammatory Drugs and things like Advil and Ibuprofen with regard to acute pain and the recovery process and maybe precautions and things that can be damaging?
The primary thing that I focused on in my research for the importance of a specific cellular response for that healing process is the health of that macrophage cell. That cell is proliferated in those early stages of the healing. It’s that zero to seven days in that acute stage. The counter medication is easily available, but that we use very regularly as the non-steroidal anti-inflammatories like Motrin and Advil. Those specifically focus on decreasing the production of those macrophages in that acute stage. As far as healing, without those macrophages for the soft tissue healing or bone healing and their transition, if you don’t have them present, if your body hasn’t made them in those acute stages because you’ve turned that process off. They’re not there to finish up the process in the intermediate and remodeling phases.
The main reason people reach for those over the counter medications is that they’re scared of pain. They want to stop the pain. In stopping the pain in that way, they’ve stopped their ability to heal from the pain for that particular acute phase. With the NSAIDs and although these aren’t over the counter, in my chronic regional pain patient case scenario, the use of opiates is also a big problem, particularly as it relates to addiction. It does nothing to allow or facilitate our natural healing process.
Do you see that a lot in the athletes? Are you treating them whether they’re weekend warriors? Do you see that they’re prescribed opiates for pain?
Sometimes, and it depends. You’ve seen back pain patients and these people feel crippled. They’re crawling into the clinic because they just need the right thing, but they often will get opiates because they ended up in the ER first before they come to you in the clinic. They hurt their back from doing deadlifts. It’s maybe rarer. This is a different rabbit hole about opiates. I think they get more than what they need. That zero to three days for a naïve patient is about all you need in post-operatively. I have a lot of athletes who have torn their ACL. They ended up going to get ACL surgery and they end up with these months’ worth of opiates when they just need to be able to get through those first few days. Although opiates don’t disrupt the macrophage development and there are acute stages, it creates a whole host of different problems related to pain and things like that.
Is there a pattern of eating or nutrition that you recommend for patients interacting with acute pain?
Yes, and maybe one of the most important things I try to focus on is simply whole foods which are naturally gluten-free so that we’re avoiding those inflammatory components of processed foods especially refined sugars. I try to make sure that people are eating a serving of protein in those early stages because that’s so important to get those amino acids over trying to get those things from a protein shake constantly. In the athletic world, people are very drawn to protein shakes. They certainly have their value and there are some good ones. As a general rule, I focus on whole nutrient dense foods and be sure that people are incorporating a serving of whole sources of animal protein, especially in those recovery phases. It’s also best to get it from its whole source.
It’s not just the amino acids, but there are other types of vitamins.
There are vitamin B12 and good sources of red meat, omega-3 fatty acids and seafood. There are a lot of important components.
There are lots of good things and a good healthy piece of protein that’s needed during the recovery phase. Let’s start to talk into your journey and your exploration of doing some research. You had research on macrophages, but then you’re starting to say, “There’s a missing link here from the episode care of an acute athlete who has an injury and has pain.” How did that all start to come to fruition? You did the research on your own. It wasn’t through a PhD program or anything.
I did much of the research on my own because I had this chronic regional pain syndrome patient sitting in front of me. I’m like, “What do I need to do? Why did this happen?” I then got a couple more and I was like, “Why does this keep happening?” I have to say personally, it also has to do with whom I married and not only my line of work but my husband’s line of work. He’s an orthopedic surgeon. We share cases and difficulties and challenges. We’re also both active physically. I am not only treating athletes but watching what athletes are doing. It was a culmination. I wanted to treat my patient in the best way that was going to be the most effective and I made these connections and then witnessing how there was this gap within the rest of the allopathic healthcare community. We’re throwing pharmaceuticals at people and realizing why do they keep coming back? It’s not solving the problem. That’s not unique necessarily to me. A lot of healthcare providers or patients are noticing that.
How long did you research for it and what did that look like?
The first CRPS patient I had was a few years ago. It was when this all started. It’s been off and on. In the past few years, when I had a mother come in to see me recovering from a hip injury, it struck me. These people need to get better because they have little people to raise. I’m a mother myself. It’s in the past few years that I started to focus my energies on how we’re treating acute pain and how shifting our concept of how we’re treating the acute pain. It will do a great deal of not only reversing certain problems but as a preventative measure and truly be able to recover.
As you start to look into the nutrition and supplementation realm of what was missing, what things did you unearth?
What I started to unearth as you have appreciated this is I went to PubMed and doing all the basic science research. What I had thought was alternative care and alternative supplements that were validated in the literature. All of a sudden, I was finding all of this information about vitamin, mineral supplementation, herbal supplementation and lifestyle intervention that was showing statistical support for improvement in healing, particularly in the orthopedic literature. It’s also the dental surgery literature and plastic surgery literature for wound healing. I was like, “This isn’t just chiropractors or acupuncturists doing this. There is strong support.”
I’ve seen it too in the plastic surgery research. When I wrote my book, I came across similar things. It makes sense. You’re going to a plastic surgeon because you’re concerned about how you look and you want to be able to recover fast and you want to recover with new tissue that is beautiful and vibrant. I’m like, “This is so interesting that this is in plastic surgery.” It’s not just an aesthetic part. Plastic surgery falls into the realm of trauma. It’s so interesting that’s informing healthcare in a lot of different ways.
That’s what tipped the balance for me. I started becoming more vocal when I was starting to see all the literature and the scientific support of something that I had thought was nonexistent. I didn’t get exposed to it in school and it wasn’t in our journals specifically. Things are shifting slowly.
The wheels are slowly turning. They are shifting more in the way professionals are thinking before the actual journals are writing about it, which is interesting. When I went to school, it was like, “The research is going to inform your practice.” I believe now we’re starting to see because of the internet, because of my show and many others out there that are talking about these things. Our practice and our belief system are informing the research or our beliefs and our theories are being tested in the literature, which is interesting. It also makes me think that our state boards and our national boards are behind. If you’re at home and you’re in PubMed, you were trained to read research with the critical eye. You know what a pilot study is, you know what an RCT is, you know what a systematic review is, you know what a single case design is so you go into lunch now and you start to look at these things. You said, “It’s in the literature but it’s not being taught in school.” We know that there’s a huge disconnect between literature, school and practice. That triangle is almost like the Bermuda Triangle to me.
It takes many years at a minimum from the research or something to validate a significant change to actual practice. That’s a long time. I’m finding that it seems longer in the same phase.
I started doing nutrition with my patients in 1998 and I’m not in deep nutrition. There were more things like, “Skip the dessert,” just to help people with weight loss. It’s super basic. Anyone knows that stuff. Even that, it wasn’t even poking in. People like you are starting to delve into things and you’re like, “We don’t have many years. This mom has CRPS and she wants to get back to running and taking care of her two babies at home. Let’s try some curcumin. Let’s see what happens. We’re not going to hurt the person.” Chances of you hurting someone with nutraceuticals or vitamin and mineral supplements are extremely low.
Your biggest risk is it doesn’t change anything. Your biggest risk here is nothing changes with the supplement. It’s not that you’ve injured them by giving them the supplement.
People are more likely to get injured by manual therapy and the exercise you’re giving them versus the vitamin. What types of nutraceuticals you look into that have shown some support?
I went into the nutraceutical research initially to debunk it. I went in to say, “All you need to do is eat well, move well and sleep well. You don’t need supplements.” What I started to find with things like curcumin, vitamin D3, probiotics, enzymes and vitamin C was this plethora of pain reduction, improved healing, gut healing, calming of the nervous system and all of these things. I would find all of this support and I said, “I just validated the very thing that I thought wasn’t necessary.” What I also noticed is human behavior change is very difficult to achieve. There are a lot of habits and cultural shifts related particularly to nutrition that become these big barriers that it’s sometimes hard to get by and there are addictive tendencies for foods. You’re dealing with addiction with specific foods.
When I was working on this nutraceutical to say it’s not necessary, I realized that it’s helping even when they’re not changing the lifestyle of people. They’re not controlling for food and nutrition. They’re not controlling for sleep. They’re not controlling for movement or what I call connection in the brain health. I started using the recipe I came up with. We talked about these validated components nutraceuticals and I would use them as a means to piggyback with certain behavioral changes, particularly in nutrition. “When you take these supplements, you need to eat a nutritious meal with a serving of animal protein, fruits, vegetables and fresh water.” I was inadvertently and I could get one meal a day or maybe two, depending on how often they were taking them. Some people were on board with that and some people would take the supplements alone.
The thing was everyone started feeling better for different reasons. I’d still be working on all those important foundational lifestyle medicine strategies, but the supplements helped support any of those changes. People would start to feel better and then they would be willing to try some of these other things. I went into the nutraceutical research initially to debunk that there would be any need for it and what I found was a plethora of evidence that supports it being a part of the process of healing, particularly in those acute stages. If you think about it, we’re constantly in a state of repair and remodeling living our lives. We always have a state of remodeling for whatever reason it is. It became something that not only what I use in those acute injury states, but I had people who were taking it every day including my husband and me. We realized that this was this support to normalize our natural inflammatory process on a regular basis. If we worked out hard, we upped it a bit to give us that extra support. If we had additional times of stress in our lives and I’ve had other patients and clients who have used it very much the same way, they simply feel better and they get more bang for their buck and their investment to their health.
There are so many people that are not eating three meals that are healthy and nutritious. The fact that you can get them to eat one where you’re like, “I’m going to sit down for lunch and I’m going to have a healthy nutritious meal per Carolyn’s recommendations with a few nutraceuticals that she’s offering.” That right there is a huge behavior change because if you look at the research behind diet and if you look at the research behind people who have to take life-saving medications for their heart or for cancer, the rates of people being noncompliant with them are huge. That’s for someone’s safety of their life. The fact that you can work that into a plan and makes them change is huge. The other thing that a lot of practitioners who aren’t well-versed in nutrition is that when you take supplements every day, you’re building a metabolic reserve for yourself and you’re helping your body be more physiologically resilient to what might come up. Meaning, if that day you decide, “Instead of a twenty-minute workout, I’m going to do a 40-minute workout.” You have all of a sudden increased your exercise.
It is an acute inflammatory trauma control.
It’s a small tag in your muscle. Your body has to come in the repair and lay down new muscle tissue. It’s a small inflammatory process or you’ve been doing great for the whole year. You’ve been healthy and you feel great and then the holidays come and one of your kids is sick, you get sick, plus you have all the holiday stress of things going on. Your body is going to use more of its nutrients if it has something to replenish itself with rapidly both through food and maybe through supplements sport that it just makes more sense.
It allows you to be more resilient through that. That’s where the big shift came for me. When I sought to research the supplements to disprove nutraceutical use, I found that I then proved that they are supportive even without changing anything else. I saw that it was helpful for shifting behavior even if it was only once a day and I would try to get it twice a day, it would help people shift a little bit in providing one minor shift and provide that resiliency and the foundational products that you need. It’s the amino acids, the proteins, the antioxidants, fiber and all of those things that promote healing, gut health and brain health. I saw clinical changes. I would watch people have full knee reconstructions and use one to two opiates and that was it. Then they weren’t taking pain medicine and they would heal up phenomenally well. People who were living their active lifestyle and their fitness routines were able to handle the life stressors better. I have one client who is going through significant life stress and it’s not one that she can simply remove herself from. She has to sustain this for a while until things get better. It allowed her to continue to function without getting derailed.
I just had this exact conversation with a PT colleague who does not integrate nutrition. We were talking about a client who I have who is going through life problem that we all go through sometimes in life that we all wind up in places that are tough. It’s affected her sleep and she’s doing everything. She has a healthy diet, she exercises moderately, she keeps a schedule and she’s off her phone. She’s doing everything she possibly can. She meditates in the morning. She checked me off all the major boxes so I said, “Try one milligram of Melatonin about 40 minutes before you go to bed and see how that does.” My friend was like, “You need to do more lifestyle education.” I said, “There are a time and a place for counseling on lifestyle.” If you’re sitting down with that client and they’re like, “I’ve done all these things. Thanks for double checking this thing. I’ve done those. I’m going through a divorce and it’s nasty. I’m not sleeping, which is causing my neck to hurt.” As a clinician and you’re putting these things together, it’s one milligram of Melatonin for a relatively healthy individual who is not on any other medications. You don’t have to worry about it. It’s fine.
One of my biggest goals is to help clinicians understand that people are coming to you because they’re looking for a solution to their problem. We all come to the table with a bag of tricks that we’ve been given and now it’s your job to keep adding to that bag of tricks as you become a seasoned professional. Use them in the most effective way both through research and both of what you see in clinical practice to help your client, which you have done beautifully. You’ve started to segue that into your own line of nutraceuticals. Can you tell us a little bit about that and how that came about?
The original way I was using it was rather expensive to maintain the quality and I had all the separate pills and a little packet. It became difficult both from a cost-prohibitive standpoint from the consumer point of view, but I had difficulty finding a supplement company that could provide the quality I was looking for and the form I was looking for. I have the five components into one pill because the convenience factor is huge. You’re going to improve your follow-through with a patient if it’s convenient. With this VitaKinetics line of active recovery blend, I was able to work with a company and we got quality ingredients and putting it into one pill. It’s one bottle versus having five or six separate bottles on your countertop. In doing so, I’m keeping the cost in line with something that I feel is much more doable for patients. I’m excited about that. Originally, I was going into the nutraceutical part to disprove its need and my goal with this is to make it available. If it’s not available to the athletes, the mom, the dad, the professional working, then you’re going to be much less likely to do it if you have to worry about five separate bottles. I’m excited about the VitaKinetics line.
Tell them where they can learn more about that.
They can learn more about it at VitaKinetics.com. The supplement itself will be coming out soon. Hopefully, within the next couple of months, it will be ready for purchase to go. I’m just tying up some of those loosens and getting all of those things in line.
I know you put a lot of work into it. I know it’s a lot of work to take the research, try it out and then put in one pill. It’s very difficult to get certain combinations of nutraceuticals into one pill for various reasons. Some of it is based on cost and some of it is based on the delivery method. You did a lot of work so congratulations.
Let’s dip our toe into a little bit of a place that might be a little uncomfortable. What’s the allopathic community’s response been to some of the innovative ventures that you’ve had taken on?
As I have shared with you in the past, I’ve done a lot of soul searching with understanding their rejection of it. I had tried to approach my husband’s orthopedic surgery group who responded very much so it wasn’t a no thank you or even a concern. I was expecting the allopathic community to be concerned with the scientific support in the literature. It seems to be more about a belief system than it does about the evidence-based presentation. That I wasn’t truly expecting. However, I am grateful. I’m working on my gratitude towards that because if I hadn’t had that rejection, I wouldn’t have been willing or moved to launch it in this VitaKinetics form. I wouldn’t have been forced into that creative space. How can I make this better, more affordable and convenient? I want this available for myself because I use it but also for patients, clients, active athletes and parents. That rejection has sent me on this trajectory that I am grateful for. If those relationships with allopathic healthcare ever shift or change, this will be here.
It’s shifting already. That big boat is slower to shift than some of the other ones out there.
I am noticing that there are healthcare providers that while I was experimenting with it, a chiropractor here in town who also works closely with a spinal surgeon. They’re anxiously waiting for it to be available again because they witnessed how dramatically it helped improve their recovery times. I have active athletes in the CrossFit world and the fitness community who are also anxiously waiting because they also have experienced how it’s helped them in their recovery phase. It’s been a challenge with the allopathic community, but I suppose without that challenge it wouldn’t have launched me into it.
From a business perspective, it forces you to find the pool of people that are hungry and are looking for that solution. They’re definitely out there. They’re reading this blog and they follow my show and other shows like these for that reason. They’d been down certain routes that haven’t worked for them and they’re looking for, “Who out there is looking for new keys to the success that all of us wished to have as far as our health and vitality goes?”
One of the things that your show does for people is giving them reliable and solid information because in that athletics supplement world, there is so much stuff out there and available to consumers that are not beneficial. It’s nice to have resources like your blog that people can read to get solid information.
If you want to check out Carolyn’s products, you can go to VitaKinetics.com. I want to thank you, Carolyn, for joining us the second time on the show. Maybe we’ll come back in another time and a few months. Give us an update on how the whole VitaKinetics is going and some more success stories. If you’re a practitioner or if you’re someone with pain, please make sure to share this blog with your friends and family on Facebook, Twitter, LinkedIn or whatever your favorite social media platform is. We appreciate you sharing this. Hop on to iTunes and give us a five-star review. If you’re new to the show and you enjoyed it, you can go to DrJoeTatta.com/podcast. In the upper right-hand corner, there’s a box where you can enter your name and your email address. I’ll send you the latest blog to your inbox for free each and every week. It’s been a pleasure being here with you, Carolyn. We’ll see you next time.
- Dr. Carolyn Dolan
- Integrative Pain Science Institute
- Show – previous episode with Carolyn Dolan
- iTunes – The Healing Pain Podcast
About Carolyn Dolan, PT, DPT
I received my Bachelor of Science with Honors in Biological Systems Engineering from the University of California, Davis. My Physical Therapy training began at the Graduate Program in Physical Therapy at the University of California San Francisco/ San Francisco State University where I received a Masters of Science in Physical Therapy. I then completed my Doctorate in Physical Therapy thru Mass General Hospital Institute of Health Professionals.
I am also certified in the McKenzie Method of Mechanical Diagnosis and Therapy from The McKenzie Institute, USA. I have been practicing physical therapy in a variety of settings since 2001, specifically in outpatient orthopedics since 2007. I graduated Summa Cum Laude from Hawthorn University with my Masters of Science in Holistic Nutrition in May 2017.
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