Chronically Living and how to make the most of it

Exercise for Chronic Pain with special guest Dr. Frank Nhan

August 17, 2020 Kelsey, Dr. Frank Nhan Season 1 Episode 9
Chronically Living and how to make the most of it
Exercise for Chronic Pain with special guest Dr. Frank Nhan
Chapters
Chronically Living and how to make the most of it
Exercise for Chronic Pain with special guest Dr. Frank Nhan
Aug 17, 2020 Season 1 Episode 9
Kelsey, Dr. Frank Nhan

This week's episode has a special guest, chiropractor Dr. Frank Nhan, who lends some insight on chiropractic treatments for chronic pain and chronic health conditions, as well as the benefits exercise can have on chronic pain management!

In this episode we discuss:

  • which health conditions can benefit from chiropractic care
  • why exercise is helpful for chronic pain management
  • what kinds of exercise chronic pain warriors should be doing
  • at home tips from a chiropractor's perspective
  • the body-mind connection

Guest Bio:

Dr. Frank Nhan is a practicing Doctor of Chiropractic in Toronto. He holds a Doctor of Chiropractic degree from the Canadian Memorial Chiropractic College and an Honours Bachelor of Science degree from the University of Toronto. Dr. Nhan is in certified Bio-Medical Acupuncture, and a Certified Strength and Conditioning Specialist. He is also a part-time clinical instructor at the Canadian Memorial Chiropractic College. Dr. Nhan's unique interests lay in sports related injuries, exercise rehabilitation, as well as nutritional and lifestyle management.

Follow him on Instagram @dr_nhan

Show Notes Transcript

This week's episode has a special guest, chiropractor Dr. Frank Nhan, who lends some insight on chiropractic treatments for chronic pain and chronic health conditions, as well as the benefits exercise can have on chronic pain management!

In this episode we discuss:

  • which health conditions can benefit from chiropractic care
  • why exercise is helpful for chronic pain management
  • what kinds of exercise chronic pain warriors should be doing
  • at home tips from a chiropractor's perspective
  • the body-mind connection

Guest Bio:

Dr. Frank Nhan is a practicing Doctor of Chiropractic in Toronto. He holds a Doctor of Chiropractic degree from the Canadian Memorial Chiropractic College and an Honours Bachelor of Science degree from the University of Toronto. Dr. Nhan is in certified Bio-Medical Acupuncture, and a Certified Strength and Conditioning Specialist. He is also a part-time clinical instructor at the Canadian Memorial Chiropractic College. Dr. Nhan's unique interests lay in sports related injuries, exercise rehabilitation, as well as nutritional and lifestyle management.

Follow him on Instagram @dr_nhan

Kelsey Harris:

Welcome to the chronically living and how to make the most of it podcast. I'm Kelsey Harris, a chronic pain warrior here to inspire hope and strength to the spoony community, get ready to lift each other up and find ways to live the best life possible. Hi, everyone, and thanks for tuning into the show this week. Today I have a very special guest on chiropractor, Dr. Frank Nunn. Dr. Nhan, welcome to the show. And thanks for being here.

Dr. Frank Nhan:

Thanks so much for having me on. Pretty excited to be on the show today. I think the purpose of this show is is great. And you're you're doing it for a great cause. So

Kelsey Harris:

thank you. And I am personally a huge fan of chiropractic care, I found it to be an essential part of my health care plan and and particularly pain management. So thank you for doing such a great job.

Dr. Frank Nhan:

Oh, for sure.

Kelsey Harris:

So first of all, can you tell us a bit about yourself and your practice?

Dr. Frank Nhan:

Well, I'm a chiropractor that's been practicing I practice in Toronto, Toronto, Ontario. And I've been practicing downtown for probably the past, I would say about seven, seven years or so. I've been practicing and total for about 10 years. I'm also a certified strength conditioning specialists. Which you know, for those of you who don't know, that's just fancy terms for saying I'm also a personal trainer. And I like to utilize a lot exercise and a lot about exercise therapy in my protocols and my treatment plans. I think it's very effective in terms of pain management, and even just general health. I also teach part time I teach at the Canadian Memorial chiropractic college as a clinical instructor. And I've been teaching there for about, I would say around three years or so. So, yeah.

Kelsey Harris:

Awesome. Um, so getting into kind of chronic health conditions. So what kind of health conditions can benefit from chiropractic care? And how do they benefit?

Dr. Frank Nhan:

Um, you know, I guess chiropractors are most known for treating chronic or Ms. k issues, I would say. And for MSK, meaning musculoskeletal system. For those of you that don't know, MSK, or musculoskeletal encompasses the whole sort of complex network of muscles, bones, joints, tendons, ligaments, fascia, and sort of a what you we know as, as the elements of the body, the physical body, at least, that allow us to, you know, do the things that we love to do in our day to day basis. And in terms of actually, I think we should define also though, the word chronic, for those that actually are not familiar with the medical term chronic. You know, back in the day when I was in school, chronic was anything, any condition that lasted six months or more, right. But I guess I'm getting pretty old because they updated that recently, in the last few years where it actually encompasses anything greater than three months. Okay. So you know, for all those that are listening to the podcast that might have increased your, your base of, I guess, listeners, because if you had any condition more than three months that can be considered as chronic. So, you know, chiropractors, we do treat mostly Ms. k stuff, that's sort of what we're known for. Things like chronic lower back pain, which, you know, as we know, statistically speaking, once you get lower back pain once there's a 75% likelihood to have it again and again and again. You know, chronic neck pain and chronic ankle pain, chronic headaches, so we really treat almost any anything to do with with pain in the body. Some common ones could be like arthritis, arthritis is a definitely a common chronic type of pain. That includes like osteoarthritis, rheumatoid arthritis, psoriatic arthritis. Yes. Or ankylosing spondylitis. ES, reactive arthritis. You know, there's way more types of arthritis and I think a lot of people are aware of other conditions like fibromyalgia, chronic regional pain syndrome, gout, SLV. These are just sort of a list of certain things that people might have heard about or known about, even like osteoporosis. That's another MSK condition. That's that's definitely chronic. And then we also treat non chronic conditions, or at least we help to manage them, which I think a lot of people don't realize that we do. Just like endocrine conditions like obesity, diabetes, we can definitely help to co manage these these conditions. cardiovascular disease, you know, we also call managers things like, side effects to drugs, cancer, so on so forth, and even mental illnesses as well. or mental conditions, we definitely help to co manage. Yeah,

Kelsey Harris:

yeah, it's a lot of stuff.

Dr. Frank Nhan:

So quite a bit, almost anything to do with health, we can definitely help to improve in certain areas.

Kelsey Harris:

Amazing. I actually encouraged one of my co workers recently to start using his benefits, because we have chiropractic care, cuz he was complaining about his neck being stiff, or like, I don't know if he pulled it, or he just slept on it wrong. But he was like, for like, three or four days in a row. It's like, Oh, my neck hurts. I was like, why don't you just go? Like, we haven't covered it seems silly not to go. So then he did go. And then he told me the next day, he's like, Well, that was actually life changing. I'm gonna go consistently now. I'm like,

Dr. Frank Nhan:

yeah, you know, it's crazy to kind of hear those stories, because I see them all the time. And, you know, I see these patients, and they're just like, sometimes they're just like, why haven't I come earlier? Right. So we definitely get stories like that all the time. And I think it's also because, you know, sometimes people aren't sure what chiropractors do, they're not really sure what type of treatments they would be performing. You know, there's a whole scary myth about like, you know, you're going to a chiropractor, and they're just gonna crack you. And so right, which definitely happens, this one of our tools in our toolbox. That's, that's really not the only thing we do. And a lot of people are confused about the science about it, and whatnot, as well, about the actual chiropractic adjustments,

Kelsey Harris:

right? You actually explain maybe a little bit of the science about the adjustments.

Dr. Frank Nhan:

Yeah, so you know, chiropractic adjustments, or what is also known as spinal manipulative therapy, is when we know just basically we take a joint, and we stretch that joint to a certain degree. And when it gets to a certain point, that's when you may or may not hear a pop or a crack. And, you know, it was only recently where we actually did a functional MRI to actually see visually see what happens when that crack happens. And what they did was they found that when you stretch the joint to a certain amount, you know, the joint capsule, that it sort of encapsulates the joint, it stretches and creates all this pressure, negative pressure within the joint. And all of a sudden, there's a big air bubble that forms inside the joint. And that's that popping noise that year, almost like when you open a can of soda, right, and you hear that pop. And that sort of pop is is a bigger bubble forming in the joint. And that usually gives a lot of relief because it releases, you know, endorphins and enkephalins, these natural painkillers. And also, because there's a big bubble inside, it kind of stretches the joint out. So it kind of helps to really stretch out that joint, if that joint was very loose, or if it was very tight, it would induce looseness into it, and overall, making it move a little bit better. So there's definitely Rolly research around the field to kind of understand, you know, we've always known that the these, what we call cavitations, or the popping noises, help to make patients feel better, but a lot of research is being done right now to actually show the actual effects and physiology behind it. So it's really interesting.

Kelsey Harris:

Cool, um, how often should people be getting things like adjustments?

Dr. Frank Nhan:

Now, that's, that's a really great question. You know, I always answer this this question with with the phrase of as often as needed, okay. So it only makes sense. You don't want to get over treated. And you don't want to get undertreated. Right. So, every person is different, and so is every condition. So the, you know, the best thing to do is get diagnosed, right? So as doctors of chiropractic, that's one of our specialties is actually to be able to diagnose doing a full history, a full physical exam, and then coming up with a diagnosis to figure out okay, do you even need an adjustment because sometimes you you don't. And once diagnosed, that can sort of dictate how often how frequent you should be getting adjusted right? So you know, if it is like your first time going to a chiropractor and you do have chronic condition, I would say what to expect is obviously a expectable history and physical examination. And then, you know, hopefully, the chiropractor will do a pretty good job in explaining what your condition is and how they can help and treatment plan itself. And in terms of the treatment plan, you might expect to see more frequent visits in the beginning. And as you know, as you get better and better, the frequency of visits should eventually decrease with the provision that you know, there's more active care being prescribed, right? So it's almost like, you have to earn the right to see the chiropractor less by doing your homework, right. So the more you take care of yourself, the less you have to see anybody else to have them take care of you for you. Right?

Kelsey Harris:

That makes sense.

Dr. Frank Nhan:

Yeah. So in terms of adjustments, you know, that goes along with the same type of frequency, you might expect adjustments more frequently in the beginning of therapy. And then as you get better and better and feel better and better, the frequency might or should decrease.

Kelsey Harris:

Right, cool. Yeah, which I think it makes sense. Because even when we were, everything was closed because of the pandemic, and I wasn't able to see you. But I had done a lot of the exercises and stretches and stuff that you had given me. And I was actually able to last a pretty long time without being able to see you. So I think that that makes a lot of sense what you just said,

Dr. Frank Nhan:

which is amazing, right? Like that, that goes to show how much you've, you know, worked on your your own self care and how much you've taken responsibility for your own health and take it into your own hands. Right. So that's amazing. Good for you.

Kelsey Harris:

Thank you. Um, so you mentioned that there's other things that chiropractors do other than adjustments, which I'm aware because we do other things, but could you maybe tell the listeners what, what other types of strategies and techniques you might be using with with them.

Dr. Frank Nhan:

Other techniques in therapy could include like, a less intense, I guess, you can say, a less intense version of manipulation or adjustments, which, which we call mobilizations, where we do a gentle stretch, it's usually slower and speed and a little bit lighter. We also do soft tissue or soft tissue therapy. We do stretch therapy as well, of course, we can use different modalities as well, which include like electrical therapy, laser ultrasound, so on so forth. But, you know, a huge modality that I think is very powerful with that, you know, we have in our toolbox is lifestyle modification. And that includes things like diet, and exercise, right? Which is huge, like, huge, huge, huge. So, you know, utilizing all of these things together in our toolbox to kind of figure out, okay, what's the best treatment for this type of patient, right? instead of just having one tool and just using that?

Kelsey Harris:

Hmm, yeah, for sure. So speaking of exercise, a lot of people with chronic pain or are scared to do exercise, because they think it's going to either hurt them more, or with some conditions, maybe make them think that they're going to be really tired or exhausted after. So what kind of exercise is helpful for chronic pain?

Dr. Frank Nhan:

I guess that's that's a pretty good question. Because, you know, with with chronic pain, you can have pain with exercise. And this is a real phenomenon, and what we also call post exercise flare ups, right? So with any belt of exercise, that can cause an increased aggravation of their symptoms, and it's mainly because they're altered immune response, where they start increasing pro inflammatory mediators that can actually cause like, these painful receptors to kind of have a lower threshold. So it actually stimulates more pain, rather than if if a person that didn't have chronic pain exercised. And, you know, in terms of what kind of exercise, you know, there's that's a great question, too. You know, there's there's the discussion of, you know, cardio versus resistance training. There's also frequency and duration, how often I should work out how long it should work out. And I guess it's really to answer that question. It's kind of hard because, again, it's one of those questions of it depends,

Kelsey Harris:

right,

Dr. Frank Nhan:

right. I'll give you an example. For certain conditions. There's, there's evidence for certain types of prescription of exercise. So let's take a second condition. Like, like anxiety and depression. So for because these are definitely comorbidities with people with chronic pain. So anxiety, the research shows that a good thing, sort of a good area to aim for is about 20 to 40 minutes of exercise. And the level of exercise should be moderate in nature, right. And this has been shown to be pretty effective if you do this about three to four times a week. But, you know, studies have shown that if you actually do intense levels of exercise, that actually doesn't really have much an effect on their anxiety. In fact, sometimes it can actually make their anxiety worse. Oh, interesting. Yeah. So, so there is sometimes specific prescriptions, which researchers still kind of diving into. So that that's sort of for anxiety and depression. Research kind of shows in in the area of 30 minutes as well. But actually, they've shown that high intensity exercise is actually very beneficial and helpful for depression. And again, that's sort of at a three times per week, sort of prescription. So, however, you know, most conditions don't really have a study parameters on what kind of exercises are the best, what kind of dosage is the best. So like I said, it really depends. And an exercise prescription should always be sort of catered to the individual considering their state of health and fitness level at the same time, right? So you don't want to start someone who's never exercised in the life and start an intense program like CrossFit, or something like that, right? You know, you always want to start slow, I usually say,

Kelsey Harris:

Yeah, that makes sense. Because again, when I, when I started to exercise, again, I started off, like, pretty easy, and then kind of worked my way up to being able to do stuff more intense, because I don't think I could have it. So

Dr. Frank Nhan:

yeah, for sure, like, you know, start with the fundamentals, start with the basics, I would say if this is sort of your first time or you're trying to get into exercise, start with some basic exercising, like it could even just be a walking program, right. And then you progressively get into a walker run program where you combine bouts of walking, and then bouts of running, right. And then eventually you get into full jogging. And then, you know, other exercises that are you know, pretty basic include swimming, right? Swimming is another great one where it's non weight bearing, if pressure on the joints is an issue, and then we can get into more intense things like resistance training. And exercise should always be geared towards progressing, right? So meaning getting better and better getting stronger and stronger. So that also means getting to do more harder and harder exercises. Right. So that should always be the goal with health and with performance as well.

Kelsey Harris:

Yeah, that makes sense. What what are the benefits of doing exercise at all? Like why should someone with chronic pain even bother?

Dr. Frank Nhan:

Oh, man, that's that's a that's a really good question. So some of the benefits? Well, there is this, there was an interesting Scandinavian study that was published in like 2015 that actually outline all the evidence of current date for 26 different chronic diseases. And and why exercise was so supported in prescription for their treatment. And so, you know, when we look at why it's so helpful, in exercise itself, you know, nowadays we're actually calling exercise as medicine. that's a that's a big term right now. And one of the biggest reasons is, there is an exercise induced hypo analgesic effect, which in short, also means that, you know, when you exercise, you relieve pain, which is pretty cool. And some of the mechanisms that we've seen that that does this is it releases endogenous opioids and endo cannot can opioids which basically cause an antinociception, which basically means it actually relieves pain, it actually blocks you from feeling pain. So there's that pain relieving mechanism. And the other thing that sort of we're speculating and some research has shown, his exercise is actually painful, actually does cause pain. So you know, you've probably done a pretty, you know, intense workout where it was pretty painful while doing it, right. Yeah, so the bodies are sort of the brain is really interesting because the brain can actually be conditioned to modulate the signals. Meaning if you do it enough times, that the brain almost desensitizes you to these, the stimuli. And so when you do it again, it doesn't hurt as much, right. So there's this cool aspect of pain modulation through the central nervous system or the brain. Another benefit of why people should be exercising, when they have chronic pain is, you know, something as simple as it strengthens you. And it makes you more stable. So it strengthens your muscles. So that when you are moving, you move in a more coordinated manner, and a manner that you're supposed to which, which helps you relieve pressure on certain joints and increasing support of the joint itself. It should also reduce stiffness. So that's a, that's a major bonus of exercising, another big benefit of exercising is weight loss, right? with, you know, with more exercise, if you are overweight, to some degree, that will help you to burn fat. And with weight loss, that obviously leads to decreasing pressure on joints. It also contributes to reduction of inflammation in the body as well, which research has shown, which is very beneficial, obviously, for pain.

Kelsey Harris:

Yeah.

Dr. Frank Nhan:

And it's also been shown to affect the metabolism of the body and the different anatomical structures. So injured sites or injured parts of the body, and allows, you know, more nutrients to get in and exchange a waste product. So it kind of helps in that that aspect as well. You know, when we talk about exercise for other conditions, like mental health, there's, there's this hypothesis of what we call a distraction hypothesis as well, where, you know, people who are stressed or who are anxious when they exercise, it almost, they think that there's a distraction mechanism that actually helps them sort of combat their their mental condition, right. It's also theories of serotonin being released from from exercise as well, decrease of cortisol levels, which is, you know, the stress hormone in our body. It also changes our our brainwaves as well. And some studies have shown that it increases alpha brainwaves, which are sort of the, the brain frequency that we have when we are very relaxed, okay, a very mid meditative state. You know, some research has shown that if you do get to a level of exercise, and tap into what we call a flow state, I don't know if you're familiar with what the flow state is, but I can actually stimulate those those alpha brainwaves as well. Which is pretty cool. You know, some research has shown that that helps with your sleep, right? Which is obviously super important for healing. Yeah, when you have chronic pain, it also increases you know, your your self efficacy, and you kind of feel like you're in control of your life, right? When you're Yeah, totally. Yeah, exactly. So that's a huge benefit as well. You know, there, there's a mention one more study, in 2017, there's this crop Cochrane Review. And if you know much about studies and journals, Cochrane is sort of the pinnacle of research, okay. And there was a study that they did, it was it was called the physical activity and exercise for chronic pain in adults, an overview of Cochrane Reviews. So they took a whole bunch of studies and they looked at the evidence, and what they were able to find was, there's evidence that suggests physical activity and exercise is an intervention with fewer adverse events, and may improve pain severity and physical function. And consequently, quality of life, which is huge, like a Cochrane is saying this, this is pretty huge, meaning there's a huge body of evidence actually supports this.

Kelsey Harris:

That's really cool.

Dr. Frank Nhan:

Yeah.

Kelsey Harris:

So I've definitely found that exercising regularly has helped with my pain levels a lot. So I definitely am a big fan of that. Personally, I always try to push myself to kind of my edge of where I as far as I can go with exercise. But But, you know, to the place where I would go without causing more pain,

Dr. Frank Nhan:

that's exactly it. That's that's where like, you know, you you want to you want to test yourself right when you are exercising. You want to be aware of certain things like whether or not you think pain, but the whole goal is, you know, do push yourself as much as you can. But never, never go into that point of pain, right? See how far you can go test your limits. And if you're starting to feel uneasy or uncomfortable, then you can back up a little bit. But, you know, the goal is to progressively get better and better gets stronger and stronger, and so on. so forth. Right? It's amazing.

Kelsey Harris:

Yeah. Is there is what's the safest way to find your edge? Is it just kind of trial and error and hope for the best? Or?

Dr. Frank Nhan:

Again, that's, that's such a good question. Because typically, for the typical person, we use pain as our mechanism to tell us if there's danger. And so pain is a usually a pretty good guy to say whether or not you know, you're exercising and safe ranges. And, you know, usually there's a difference between good pain and bad pain, there's a good pain of like a good burn, right? Like, I'm getting tired, I'm really feeling fatigue in this muscle. But then there's the bad pain of Whoo, this, this kind of doesn't feel too good. I feel like I might injure myself. And so usually, for people without chronic pain, this is a pretty good guy. However, people with chronic pain, you know, the research has shown that this, this pain sensor is a little bit off. Right? So things that are not normally painful, become painful. So, so we have to kind of be careful with this. And, and to be honest, my best answer for this question is to seek a professional, right, right. And they'll be able to sort of guide you and give you the appropriate exercises, to say like, you know, at your level, this is what you should be doing. Or you should be doing it this way instead of that way, or give you alternative exercises instead. But, you know, like I said, Every person is different, and every condition is different. So you really have to find the exercise or activity that's best suited for you, that will cause minimal pain, or discomfort, right? And like you were saying, you want to you want to test your capacity, right? You want to, you know, figure out, you know, how far you can take yourself, but without causing you that much pain or discomfort. And that that comes with a level of self awareness, right? You know, training that self awareness to be able to detect, okay, how do I feel while I'm doing this? Is this painful? Is this good pain? Is this bad pain? What's my heart rate app? How's my breathing? How do I feel? What's my mood? Or what's my mentality when I'm doing this exercise? Because, you know, a lot of times if I prescribe an exercise, and the patient hates it, you know, most likely it's probably not going to benefit them, right. So, you know, exercise should be enjoyable. And that's why I always say, find something that you do enjoy. Right. So let's find more important

Kelsey Harris:

because you actually, like, a long time ago, you prescribed me to do planks. So from planks and side planks, and I initially hated doing there though, and now I actually and I could only do them for like a front plank for like, 45 seconds, like a talk like that. But I actually now really enjoy doing planks. And I can do, I don't like to do them this long. But I can do a front plank for like, a minute and 15 seconds. It's amazing. Yes. But I like even though I didn't like doing it. I was like, I see that there is a health benefit in this. So I'm just gonna do it anyway.

Dr. Frank Nhan:

Yeah. And that's sort of the part of the brain conditioning where it's like, it's realizing after it sees the benefits from certain exercises, that's when it can get addictive almost. Yeah, right to keep doing the exercise because they like, oh, man, I feel pretty good doing this. And I see the benefits and so they just get addicted to the benefits of it, but not necessarily during you know, the exercise because like we said, it can be painful, right? Yeah. So I don't know if your might be sadistic as a pain, but hey, maybe your own to each their own.

Kelsey Harris:

yeah exactly. Um, so some of some of the listeners might not be able to afford to see a chiropractor. Obviously, everybody's got different health benefits coverage or, you know, live in different parts of the world where we're things are more expensive for life less expensive. So what are some things that they could practical things people can do at home to kind of get them through either between visits? Or if they just can't get to one at this point?

Dr. Frank Nhan:

Yeah, that's that's that's always a that's a good question to the you know it to me, it begs the other question of, you know, if you can't afford the visits, you know, what value do you hold for your own health? Right? I feel like that sort of begs that question. And, and what sort of priorities do you have? That may go beyond health? Right? You know, I do see some patients and you know, they'll, they'll openly admit that they're, they'll be more okay with spending the money to buy a pair of jeans, right,

Kelsey Harris:

wow.

Dr. Frank Nhan:

Or, you know, a lot of people will will rather use that money to go out with their friends have a night out. A lot of people have no issues with, you know, going to dinner at a restaurant and sort of paying the price for it, and traveling, you know, paying high fees to travel and, and sort of drink and alcohol. And so those things that might even be detrimental to the health.

Kelsey Harris:

Right.

Dr. Frank Nhan:

So I think I think the first question to ask when sort of thinking about that is, you know, where does health sit in all your priorities, right. And if it does, if it does set pretty high, then I would say, you know, that might cause you to change your spending habits, and maybe spend a little bit more on your health, rather than maybe some other things. But having said that, every every person has their own personal situation, which, you know, we can't really judge. So if you are part of that category that really, really can't afford much at all. Then there's, there's actually, if you're lucky enough, you might actually live in a community that has complimentary chiropractic services. So you might want to look into that. Look into these community volunteer chiropractic clinics, where chiropractors sort of just volunteer their time to service their community, for those that are really in need, but are in more poverty ish, poverty, your circumstances. So, you know, that might be something to look into other affordable options could be looking into teaching clinics. So if you again, live in an area where your closest a chiropractic educational institution or a chiropractic school, they may offer clinics with ease, where their their interns treat you instead. And these are clinics that are, you know, the there, they have fourth years. So chiropractic education is a four year program. And usually the fourth year of your program is an internship where you're, you're just treating patients the whole year. And in that sense, because you're seeing students, the fees are usually much more reduced than seeing an actual practitioner. But the good thing is, your care is usually supervised by a seasoned practitioner. So that's, that's actually what I do at at the school, that's my job. I oversee and I supervise these interns as they're treating their patients. So you get the benefit of sort of the season car Packer, overseeing your care, but also paying a reduced fee. Because the chiropractic students are those that administer the treatments. So that's one option. Some other options are looking into resources. So for whatever province or state that you might live in, there's usually a chiropractic Association websites that you can look into. And they usually have these sections in their website for for patients, and you go into those sections and you might find some self management or self care resources, that can be very helpful. So you know, some, some general basic stretches for sale or back pain or, or neck pain, and so on, so forth, that can be pretty helpful. And those are more legitimate sources than you just kind of googling or right. But otherwise, like, you know, if, if you really, you know, can't afford any of this one, one tip of advice that I would give is just really focus on things that you can do and that you can write and these are things that I mentioned these self care things like exercise and like diet, you know, reassessing Are you active what kind of activities are you doing what kind of things are you eating? right and and you know, these things can have a huge impact on your health more so than what more people most people think about and actually that's that's a big reason why I I started my social media my my Instagram page, because you know, back in the day, a lot of patients would ask me, you know, Dr. Dhan, what do you what do you eat every day or how do you trade How do you exercise right? And so, over time answering the same question over and over, I just, I just felt like I needed to make some type of resource for people. And so I just directed them to my, to my Instagram page and say, Hey, just just look at this, you know, I explain everything, everything on there, I explained how to do certain exercises that explain what the benefits are of certain diets and, and foods. And so it almost allowed me to spend more time while the patient was with me on more hands on treatment, right. So that this other aspect that was super important, like the diet exercise, they can definitely still tap into with that type of resource. Right. So yeah, I would say something to look into diet and exercise.

Kelsey Harris:

Awesome. Those are all fantastic tips. So thank you so much for those people find this very helpful. So we've we've discussed the body mind connection in the past, and you've mentioned techniques like motivational interviewing. Can you kind of elaborate on your body mind? From a chiropractic perspective?

Dr. Frank Nhan:

Yeah, for sure. Um, you know, there's this growing body of concept, I guess, you can say, the bio psychosocial model, and I know you do your your master's in mental health. Yeah, I know about it. So the bio psychosocial, you might even be a better person to talk about this model. But basically, it's, it's pretty well accepted nowadays. Because back in the day, it was more of the biomedical model that we accepted. But the the growing medical community, chiropractic included, of course, is growing into this biopsychosocial model, which really just means we take a look at the patient as a whole, their biology, their psychology, and their social environment. So all of these factors play a role in their health. And it's incorrect to say that one is, is more important than the other, or it's, or that they should be looked at individually. Because it really isn't the case it should be as a whole. Right. So that's, that's something that the at least the newer generation, chiropractors are sort of a learning in our educational models. And, you know, there's, there's a huge amount of research that when we talk about sort of the mind body connection, there's a huge amount of research going on right now, that sort of focuses on this stuff, right? Things like the placebo effect, the opposite the no Siebel effect, you know, certain cues that can modulate pain that actually has an effect on pain, things that we never would have even thought of, actually helped to influence our perception of pain, right? There's this really cool study in 2017. That was published, looking to see whether or not you know, people People always say they, they feel stiff, right? Some people will say they feel stiff. So one study sought, whether the, their feeling of subjective stiffness was correlated to an objecting finding, or objective finding of stiffness. And the study was pretty cool. They use this This machine was called the in den tour. And it's used to kind of poke around different areas of say, your your spine, right? So folks, it is a very controlled poke to, to control the amount of force that it uses. So it's very precise, right? And it's used to measure the amount of stiffness as well. And the the it's cool because the The study found that your perceived subjective stiffness feeling was not correlated with objective stiffness. Interesting, right? And the study went on to further do something pretty cool. What they did was they they synchronize certain sounds with when they actually pushed on your tissues or pushed on your back. And one group what they did was they they synced. The noise of like, a creaking door, right? Almost like that sound stiff, right?

Kelsey Harris:

Yeah.

Dr. Frank Nhan:

And they sync that up with the the the poking sensation that they have, and they found that and then they did another group where they they they poke them but they actually had a swishing noise associated with it so almost like a water swishing. Right. And when they did this, they found that the group that had that creaking door noise reported subjectively feeling even worse than

Kelsey Harris:

Oh, wow.

Dr. Frank Nhan:

And the other group that actually had the swishing noises, reported the feet felt less stiff, actually. So it was really interesting how these cues modulate our perception of whether we feel stiff, whether we feel pain, there's so many other cool studies like this, that actually proved to us that you know, how we perceive things, or you can say how our mind is functioning correlates with our body, right? Or at least symptoms that we feel in our body. There's, there's, there's this sort of famous stat that's kind of thrown out there in the medical community saying like, you know, 60 to 90% of all doctor's office visits are for stress related complaints, right? However, this this, this stat has never really been validated. Right. But there's legitimate, there's legitimacy to it right? Or at least I believe, so we're, you know, a lot of the things that we experience, definitely have a psychological component to it. Right, and it's a sort of a huge factor that plays into our health, that people kind of don't realize, there was this study, done very recently, in June of this year, in psychological science. They did a randomized control study, to see whether happiness improves health.

Kelsey Harris:

Okay.

Dr. Frank Nhan:

And they found a direct correlation, actually, that what they did was they did they had people undergo positive psychological interventions. Yeah. And they were able to prove that people that did undergo this had improvement of happiness. Yeah. But also improvement of self reported physical health. These these people actually took less sick days. While they were on this sort of intervention.

Kelsey Harris:

Yeah. So I think I actually read that study for school. That's so funny.

Dr. Frank Nhan:

Yeah, yeah. It's a pretty cool study it because it's so recent, as well, yeah, this is actually a really enlightening us on sort of the brain body connection. Right. You know, there's, there's other studies on how exercise, which, which, to me is like, you know, something to do with the body, right? When you exercise. It's correlated with lowering risk of dementia, lowering the risk of Parkinson's. And we know that these things are, you know, having to do with brain health, right, or cognitive function, right. There was there was another study in 2017, that, you know, looked at people with fibromyalgia, and a big comorbidity for fibromyalgia is depression, right. And when they looked at these people, they kind of looked at a whole spectrum of these people with fibromyalgia, and some of them had higher depression rating scales than others. And so, they follow up and ask them, What is your activity level. And when they asked them that, they found a direct correlation with those that actually, when they actually saw that they worked out or were less active, or worked out less. There, their depression scores were higher, right. And vice versa, those that worked out more had a lower depression score, which is really cool. That does kind of beg the question of like, you know, the chicken or egg, right? Was it their depression that led them to not work out as much? Or was it their workout that made them less depressed? Right. But that it goes to show that there is a direct correlation with body and mind there, right. And so I, I like the I like the quote that Jim quick gives, which is a one of the memory gurus out there. He says, As your body moves, your brain grooves, haha, like that. Yeah, it's pretty cool. And, you know, to speak of evidence for that. Albert Einstein actually came up with his eureka moment of E equals MC square while riding his bike. Pretty cool. Which is, which is pretty cool. I think. So there's a lot of new studies coming out to show how like movement and actually has a direct correlation with brain health. You know, research has shown that it even actually grows the brain. The brain actually grows in size when we exercise particularly like the frontal cortex and the hippocampus area. Yeah. It's pretty amazing. And this relates to, you know, increased memory cognitive function protects you from neurodegenerative diseases, and so on, so forth. So, you know, I think I think this type of research is really cool. that's starting to come out right now.

Kelsey Harris:

Yeah, I think it's super fascinating. I definitely, like seen in different things that I've done, you can like, if you really pay attention, you can see how the body and mind work together. And even like things when I'm more stressed, I definitely have more pain, versus when I'm relaxed. And like, I don't have like, I still have some, but like, not nearly as intense. So it's very interesting.

Dr. Frank Nhan:

Yeah, like, you'll ask anybody with chronic pain. And if they've had it long enough, they'll they'll probably tell you sort of the same things. Right. And that's one of my questions that I asked my patients, you know, during a health history is, you know, what are your aggravating factors and whether stress actually aggravate your symptoms? And, you know, more often than not, that is definitely an aggravating factor, for sure. So, right.

Kelsey Harris:

That's why it makes sense. So suddenly, one more question is, how do you inspire your clients to live an amazing life?

Dr. Frank Nhan:

Oh, man, so, you know, I like to quote, Albert Schweitzer, who is a great polymath, he always said, example, is not the main thing in influencing others, it's the only thing. So that's, that's sort of one of my big models in life is, you know, I want to inspire, through example. And for me, I sort of prioritize my health. And I try to be sort of that model that that patients can can look up to. And so, you know, I, I practice what I preach, I think that's, that's huge. And, you know, I, I truly believe that, you know, when you are seeking help, or seeking advice from someone, to, you know, not only seek advice from people who are most knowledgeable, but also from those that are most aligned, right. And so when I, when I say aligned, you know, that sort of means, are they doing what they're saying, right? and align as in is this person giving me an example of what I'm striving for? Is this person able to inspire me in whatever my specific goals are? So I sort of tried to think about it that way, in my practice, I think, for me, I also don't like to, I oftentimes don't like to prescribe treatments, or therapies, or, you know, lifestyle modifications, unless I've tried it personally, myself. Right. So I like to experiment, I take care of myself and see how it feels. So I can really just put myself in patient's shoes, to really empathize with them and to kind of see what it's like, to go through whatever they're going through, to kind of experience it in their eyes. You know, I've had my fair share of health issues and, and chronic pain as well. And chronic issues, chronic health issues. And, you know, what, over the years, I've built a sense of gratitude. I feel, I feel grateful for, you know, these these injuries that I've had, and these health problems that I've had, because, number one, it helps me empathize with my patients, really to feel how it's like to feel this, you know, tremendous pain or whatever it is. And I felt like number two, it really helped me to, to grow, to grow, you know, professionally, but also personally, right. You know, to quote, The Great Seneca it's a rough road that leads to the heights of greatness. You know, I would say to those chronic pain warriors out there, that, you know, you should be grateful This is your, your journey to greatness. Right. So, you know, I think it's, it's, it's something there's always something to learn with the st uggles that we experience for su e.

Kelsey Harris:

Yeah. No, I love that. I totally agree. I think that for me, personally, my personal journey became because of all this, and then, you know, I'm in a master's program because of all this, like, I probably wouldn't have done a lot of the things that I do, including this podcast, if I hadn't had chronic pain in the first place. So yeah, you're right.

Dr. Frank Nhan:

Yeah, you're like a shining example. Sort f what it's like to, you kno , manage your chronic pain, but n top of that, build greatne s through it. Yeah. Oh, that' , that's really Cool. That's sup r cool. Thank you proud f yoursel

Kelsey Harris:

I try. And you mentioned earlier Instagram page, where can we? Where can we follow that?

Dr. Frank Nhan:

So my Instagram handle is @dr_nhan. So dr_nhan. 'm not like super active on it anymore. I did take a littl bit of a hiatus. I felt that th t was actually it helped my m ntal health to be off of social edia for a bit. But who knows, m ybe in the future, I may do som new posts, which I most likely ill because, you know, that's o e of the things that I like to h lp inspire my patients to. But you can find me there. If you h d any specific questions or a ything like that, you can always email me. Dr. Frank, Nan, [email protected]

Kelsey Harris:

Amazing. Well, thank you. So again, so much for coming on the show. I think you gave us a ton of great information. And I really, really appreciate it. So yeah, thanks so much.

Dr. Frank Nhan:

I appreciate you and your time as well. Thank you.

Kelsey Harris:

All right, everybody. Thanks so much for listening today. Of course, you can rate and review the show on Apple podcasts and Spotify. Have a great week everyone. Thank you so much for joining me today on the chronically living podcast. If you love this week's podcast, please subscribe, rate and leave a review. Until next week, stay strong.