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Podcast Season 3 Episode 3: Dr. David Crane
On this episode of the show, I am interviewing the founder of Bluetail Medical Group, Dr. David Crane. Dr. Crane practices sports medicine and regenerative orthopedics and specializes in musculoskeletal ultrasound for diagnostic imaging and needle-guided therapies.

A Missouri native, Dr. Crane earned his medical degree from the University of Missouri School of Medicine and completed his residency in emergency medicine at Maricopa Medical Center in Phoenix. In 2008, he opened Bluetail Medical Group. Bluetail Medical Group’s qualified physicians have expertise in treating injuries and conditions, like arthritis, that affects the shoulder, elbow, hand, wrist, hip, knee, foot, ankle, and spine – all of which can be treated with stem cell therapy, platelet-rich plasma therapy (PRP), and prolotherapy.

This episode has been transcribed by otter. ai.

Hello, and welcome to STL Active St Louis's premier health and wellness podcast. STL Active aims to give listeners in the St. Louis area the information they need to succeed and progress with their health and fitness. This podcast is brought to you by stlouispt.com and hosted by Doctor of Physical Therapy, Greg Judice.


Hey everyone, it's Dr. Greg, owner, and physical therapist at Judice Sports and Rehab. On this episode of the show, I'm interviewing Dr. David Crane. Dr. Crane is a founding partner of Bluetail Medical Group, which currently holds clinics in five states including their office here in Chesterfield. Dr. Cranes' current clinical research interests include knee and spine conditions. He is currently working with the FDA on a directed and for knee osteoarthritis. Dr. Cranes, other interests are in helping patients with functional medicine, active movement, and fall mechanics. Dr. Crane and I discuss a variety of topics including his passion for Regenerative Medicine, how his practice has changed over the last couple of years, and the medical system as a whole. Without further ado, let's get into the interview with Dr. David Crane. Alright guys, welcome to the show, Dr. David Crane. I appreciate you being here. Dr. Crane is from Bluetail Medical Group. Why don't you introduce yourself to the listeners, tell us kind of your background, what you do, why you're here.


Thanks for having me, Greg, this is really fun to be on another podcast, we totally appreciate it. And so yeah, Dr. Crane and initial background, started back around 2004 with just a solo practice and came out of a academic typesetting and really saw that we as a musculoskeletal medicine practice weren't really handling a lot of the chronic degenerative conditions very well. And so we started doing regenerative medicine back in the 2004 timeframe. And then we kind of brought on partners and grew into blue tail Medical Group. And Bluetail Medical Group has been around since 2008, in multiple markets around the US, and we've been able to really help in defining what regenerative medicine is able to treat effectively and come up with good protocols for lots of different musculoskeletal conditions that are chronic and problematic to treat otherwise. And so that's really, you know, kind of my regenerative medicine background, I originally trained in emergency medicine, have a residency in emergency medicine, and then did a fellowship in sports medicine. And so I'm the non operative sports medicine kind of doctor, there's certainly operative orthopedics and spine, but the non operative sports medicine Doc's these days, you know, as we get more minimally invasive with the tools we use, and all the different techniques we have, and better placement guidance tools with ultrasound and floor scopes, and all that great stuff. We are seeing more and more of the regenitive medicine being done by non operative sports medicines in a you know, even an outpatient setting.


So why regenerative medicine in general? Like what was was there something that you were seeing a lot of before you went into private practice that, you know, kind of prompted saying I got to do something with this.
Yeah, I mean, I always tell patients, this is kind of my own self, right, the, unfortunately, I had some chronic knee pain. And that chronic knee pain started back when I was in college, and I had it for you know, 14 years and we just couldn't get it to go away. And, you know, surgery didn't help with sort of that, you know, kneecap patellar you know, injury pain that I had. And regenerative medicine was really the only thing ever took that away. So part of it was in the arena of endurance sports, whether it's triathlon or other areas where guys and gals are out working out longer distances, there tends to be a higher incidence of kind of breakdown or recovery type injuries meaning you just don't recover, don't recover, don't recover and then boom, you know, you get some tendinosis which means degenerative tendon problems on whether it's your Achilles or your rotator cuff, if you're swimming or all those different types of injuries and we just found that ibuprofen and You know, ibuprofen and other modalities that we had traditionally just weren't giving enough relief. And most of those patients are in their season, they don't want surgery, because surgery for chronic tendon problems is not great. And so really, we started originally with most endurance athletes who didn't, they didn't, they weren't interested in surgery, or they had already failed a surgery. And we went after those types of tendon problems first. And that's where most of the research came out originally, was on chronic tendon problems starting in the elbow with chronic tennis elbow problems. And so that was the only thing that really helped my knee pain to be quite honest. And so we just progressed onwards from there.
So when, how old were you? or What year was it, when you had the knee issues?


Oh, my gosh, that started back. Really, in my fellowship is when I had a knee surgery, and so that would have been in 99. So it's been a few years, okay. And then progressed on to, you know, again, but I'd had it for quite a few years at that point I was doing I was doing triathlon, and then Ironman and, and some longer distance orienteering, racing, and all the other stuff that I love to do out and outside is great, right for especially these days, right. And so the, the pain had been there for the pain and just intermittent swelling and all the stuff we tend to see with kind of things that aren't healing well over long periods of time. And we learned a lot about or I learned a lot about what we think of as inflammation in the West. And what we understand as really sort of a chronic digia, I think of it as chronic smoldering inflammation that choose the nutrition up from that body part, or that tendon, part of that joint part or, you know, cartilage, whatever. And so there's kind of the red hot, swollen and painful stuff, the classic inflammation from a beasting, I call it and then there's the chronic, smoldering, degenerative, swollen, not healing stuff, that ibuprofen and Celebrex doesn't work for.


So your body's trying to heal it, but it's just not, it's just not happening, right? I mean, your body has, you know, tried to heal tried to heal, try to heal and at some point, your body walls that segment off and says I can't do it, or the nerves increase in size and transmit more pain and there's not, there's no more, you know, sort of inflammatory cells, they're trying to chew it up and make it a different tissue, it just ignores it,
right becomes more of a like a neurogenic pain and not able to heal in the normal way.


Yeah, and you know, that chronic ingrained pain pathway that gets set up for it, and I'll use my knee as an example, again, from my knee to my brain. Once that pain pathway gets ingrained, we have to be able to change that pathway to that's one of the reasons certainly that we use, you know, things like antidepressants to help with chronic pain. And we use all kinds of things now. And now there's a bunch of new things on the horizon that we know of to help that neural retraining. And so really, the focus of Regenerative Medicine is to look at all of that, and figure out how we can change what you need to change, you know, there's sort of a critical mass of how many things you need to change to make it start to get better. And so, that was kind of a big lightbulb moment for me when I was, you know, younger physician and, you know, after two weeks, the big inflammation is going to go away, and then you're left with sort of this chronic smoldering thing. And if you're lucky, you're going to heal it. And if you're unlucky, it'll stick around for forever. I mean, I've seen guys who have shin splints from high school that still have in their 50s. And there's, you know, why is that and there's answers for it now.


Okay. So when you were a younger physician, as you put it, you had some success with having what would kind of procedure Did you have that actually did work was it stem cell it was PRP, so platelet rich plasma, platelets plasma has been around, you know, for quite some time originally started in the cardiac space using it for sternal wound closures because they had easy access on the bypass machines, you know, they were the perfusionist were kind of the people in the army who had access to blood products initially. And there's, in the world of surgery, especially blood in a wound, has always been sort of not what you were looking for. You weren't looking for red cells to be in a wound because that's, you know, is there a risk of infection that goes up and all those things. And so hemostasis which means you know, controlling blood at the, at the surgery site has always been an important part of surgery. And so everybody was worried about putting blood back into you know, space, but we're really using concentrated platelets and growth factors. And so they found if they use these uncertain When closures, they would have less pain in their sternum after having a cardiac surgery. And they had less risk of infection. So less pain, less infection healed faster. And that's kind of where platelet rich plasma started back in the, you know, days. And so using that growth factor stuff originally was, we kind of we, you know, there's there were some good animal studies, and again, there was good human studies, especially starting on out of the cardiac space, and then it jumped into the oral maxillofacial space for for dental, dental procedures and like chronic dry sock, all kinds of things. They were using the poor, and then it came back around to the musculoskeletal space.


Okay. So you were dealing with the knee pain for years. And once you finally had the PRP, was it just like that? Or
no, is it work for you? Yeah, for me, it took. And again, I had a cartilage lesion on my MRI behind my kneecap, which is classically for sports medicine guys, kind of the dark side of the moon cartilage lesions are tough. Cartilage is one of the things we've always had a hard time healing. And there's still arguments in the space. You know, if I get fiber cartilage versus articular cartilage, like what type of cartilage is it, nobody's done a great study yet where we have volunteers that we grow cartilage in their joint, and then ask you to come back and give it back to us to go test right. So that's always a little bit of a, it's always a little a little bit of a sticking point. But in the animal world, where they've done more testing on the cartilage after repair, you know, whether or not I get fibrocartilage, articular cartilage, as long as there's some cartilage covering that hole. Typically, pain and inflammation will go down. And so for me, it took a few shots in a series to really help that chronic pain and swelling on on my knee to the point where instead of being able to, you know, being limited to run 123 miles without swelling, I could go run a marathon and do fine. And that took a period of about a year. And we really started with the sort of the basic, you know, preparations of platelets, plasma. And then we, you know, subsequently progressed on to bone marrows, and that type of thing, more of the, you know, true stem cell world, how we concentrate higher order cells and tissues. And, you know, my knee would do it did really well, after a series of probably, you know, it took about five of those consistently for me on the prps, which is definitely not what we see, in today's world, classically, for our joints that have arthritis and chronic joint pain, our average series is two. And so the protocols that we use to heal, you know, whether it's arthritis or knee pain, or cartilage lesions have gotten way better. And so, you know, my knee did really well for about six to seven years, and then I needed to have another, you know, I think it was two injections in a series on my knee, because I flared it up with, you know, activity and stuff I love to do. And then it just,
that's part of it. I mean, you you weren't willing to do nothing. Yeah, I mean, you know, you could have had the PRP and felt well enough walking around the clinic or around the house, but your your hobbies, your activities were high level outdoor.


Yeah, I mean, I love to, you know, mountain bike and trail run and hike and paddle and everything in the, you know, on the under the, on the earth or whatever. But the The question is, how do we? How do we look at how the joint is repairing itself, and we're getting better at having tools like ultrasound, or like, you know, even this kind of thing, we'll get around to, I think this kind of total team approach where we have, whether it's the therapist or the trainers, or the people who have good knowledge base, who can kind of tell whether or not that joint is healing or not healing, as, and I think that there's a certain percentage of the population, for example, who can go run ultras and recover well enough, after they run the ultra, it's not the running part that really gets it. It's the are you adequately repairing between the bouts of exercise, and if you're not repairing when you sleep, then you're degenerating. So we've learned over time that every tissue in your body is replacing itself at a certain frequency, right? So every two years, your joints at every joint and every you know, every eight months, your entire, you know, your entire sort of cell volume will change over and so there's always this sort of repair process happening. That's why we have stem cells in the first place. And so, if you're not repairing, then you're then you're degenerating. So how do we make sure that you're on the, on the repair side of the fence? And there you know, there's a lot of people in sports world who are much more savvy at that and there certainly are better studies looking at, you know, heart rate variability is a good example. You know, If you're if you have signs that your heart rate variability is off, then you're in a space where you're you're at, you're not in, in rest and digest and repair, you're in, you know you're in fight or flight or
breakdown. And that kind of gets into that chronic inflammation timing, which we'll get to later.
Yeah, okay. Yeah. So I guess what sparked blue tail? I know you were kind of doing your own thing for a while. So we're, that's your current business is Bluetail. So that's, you know, what most people are going to want to hear about today. So I guess, how did you get to the point of, Alright, it's time to start blue tail. I,  think it was really, it's really rare to have a group of primary care sports medicine physicians, and we have in blue tail. You know, I'm emergency medicine based. And we have family practice, er, sports medicine based and pediatric sports medicine based and physical medicine, rehab sports medicine based. And so it's really rare to have a lot of primary care physicians who are really dedicated to regenerative medicine and in musculoskeletal medicine. And St. Louis being the market, it is certainly orthopedics is very strong here. And in the past, in the historical past, most primary care sports physicians worked under an orthopedic surgeon. And the model that we that I foresaw was that we really did need to have an arena for patients to go to when they weren't necessarily interested in surgery. But the other things that are in our initial treatment algorithm, like ibuprofen, or steroids, or relative rest, or physical therapy, or chiropractic or manual therapies don't work or hadn't worked. And so what's between ibuprofen and surgery, you know, what's in that black box, and it's a huge black box? Sure. And we're just adding more and more tools to our toolkit. And so that was really the impetus behind blue tail was to see how how much of a toolkit we could build in that black box space before to fill a gap. Yeah, to fill a gap. And that's, I mean, that's a huge step between PT and surgery, and a significant gap. So, right, and we wanted to be able to fill and unfortunately, we're seeing, you know, and we were seeing this even back in the early in, the early portion of when I started was, you're seeing more and more osteoarthritis, you're seeing more and all the chronic degenerative diseases. And certainly arthritis is one of them. But diabetes and hypertension, and heart disease, and dementia, all are going up at very similar rates. And so, you know, again, in our Western societies where there's a lot of stress, and a lot of lots of things going on that may be causational. to that. How do we sort of hold back that tide of joint replacements, for example? And the other thing was, how do we, as a physician community, actually start to capture things early? When you know, the classic scripting has been wait until it gets as bad as it can get? And then have your joint replaced? You know, how about we try to capture things early and try to you know, actually do something that changes the long term outcome of that cartilage lesion or that arthritis. And we're getting better and better that with all kinds of, you know, like, certainly, we see now so many different immune modulating drugs in the rheumatoid arthritis space, for example, the Humira is in the, and the other drugs in that space. And, but that's also true for Regenerative Medicine and stem cells. And blue tail By the way, this is you know, blue tail. I tell the story like we were trying to come up with, you know, a name for Trinity medicine clinic. And most of the original work done on bone stimulators was done in salamanders in the 1950s, believe it or not, by an orthopedic surgeon. And so these lizards in other animals that can regenerate their tails certainly are, there's a lot of them in our, in our world. And here living Missouri and living in West County, and I was standing on my, you know, back kind of porch area and this nice these beautiful blue tailed lizards around and they use that tail as a lure. And if it's going to get attacked by a bird or whatever predator drops a tail and the lizard runs off and grows another tail, right? It's pretty amazing model. And so it's just a beautiful model for for what happens in regenitive. lizards.


Absolutely. So they're able to completely regenerate that tail. like it never happened.


Pretty much. Some lizards can regenerate better than others all and like some animals can regenerate better than others. You know, certainly, starfish can regenerate an entire And octopus can return. You know, and hydrous I thought it sounded a lot better blue tail sounds a lot better than hydref right now. I agree. Sounds like a get smart. Yeah, evil layer. But yeah, blue tail. That's how blue tail. That's how the name was was formed. Very cool actually learned that from my old mentor.
You did? Yes. Sweet.


Oh, Steve through? I don't know. Yeah. worked with him for a while. So I wanted to touch on something you mentioned catching it early. And I see that so often that when someone comes into my office, right, that's, you know, theoretically the box before they get to you guys, right? They come in and it's so bad, right that that issue has been there for 15 years? Yeah, I just never dealt with it,
I thought it would go away. And it just you know, that arthritic or that painful elbow, painful knee. Or they tried to deal with it. And they got advice of wait until it gets as bad as it can get or there's nothing we can do except take you know, Celebrex or something.
So I guess how do you change that mentality? I mean, is that public outreach is that education isn't marketing? Like? I know, that's a huge question. But
yeah, how do
we change that as a?
I think that's changing as a group of providers? Yeah, I think I think a lot of our US population are getting smarter. And there's certainly much more in the common vernacular about inflammation and anti-inflammatory diets and all the things that lead to chronic inflammation. And I think there certainly are always going to be patients who just want the so called Quick Fix of surgery, which is, I understand that wish, like, I'm as impatient as every other human on the planet. So I think that it has to be some level of education really, quite honestly, starting in school, and in and in grade schools, to be quite honest, I went into a great school, for example, one year when my kids were younger, and within, you know, ultrasound, just to look at muscles moving under the skin, and all kinds of fun stuff. And I asked a bunch of fifth-graders, how many people in this fifth-grade class think of stem cells as bad and half the room raises their hands. And it's, it's super disheartening, when, you know, we've all sort of been told, as older adults, your stem cells are too old, or they're not powerful enough, or, you know, this, the embryonic stem cells sort of argument has kind of gone away to some degree, because we really haven't needed them, quite frankly, we were using a lot of amnion cells, which aren't, those are adult-derived cells, and we're using, you know, those aren't really stem cells, they're just, you know, growth factors and cells, or we're using bone marrow cells. And some of those, I was gonna ask that question, because I'm sure by using stem cells, some people are thinking, you know, what the worst right there? Yeah, embryonic and yeah, absolutely. And so, right,
you know, I've shattered at your facility. So I know that that's not what you're using, because it's being extracted from each person, right individuals. So I guess maybe touch on that a little bit. Just briefly.


Yeah, it's a, it's a, in now, it's, it's everything. You know, we always think we know the answer early on to Oh, this is how it works. And I just put a stem cell in there. And it looks at the tissue and grows new tissue, right? It's amazing. And we actually learned that that's not how stem cells work. And so that's still we're still gaining knowledge on how stem cells actually signal for growth and repair. And we can get down in the weeds in that if people want to hear about it. But the original arguments that we had were based around, you know, embryonic versus non embryonic, and there's certainly a lot of there's a lot of personal belief and religious belief around not using embryonic cells. And I don't think we need to argue that today. I think that really quite honestly the amount of tissues that we can repair or do repair on. Including, you know, nerves and skin and hair and bone and joints. And, you know, honestly, most of the tissues can be repaired or healed to some degree with adult derived cells, stem cells. And your stem cells are working until the day you die. So if, if you're not repairing, then you're gonna die. If your stem cells are not working, your bone marrow shuts down. that's a that's a fatal disease. So The question is, what is the number needed to treat? And this is where we'll get into the FDA talking a little bit. But how much how many stem cells do we really need to use to make that tissue do or start repair again. And that's kind of, really again, where we're heading with the studies, and the FDA is asking for that number and all these things. And that's an appropriate question to ask. But quite frankly, it's probably different for everybody. Right? It's different for, like, if I'm, I talked about the, the, the chronic pillars of the chronic inflammation pillars, and we're learning a lot more about the microbiome now. And we're learning a lot more about bioidentical hormones, and we're learning a lot more about, you know, the metabolism, which is, you know, how your mitochondria provide energy to these whole systems. And if you're around, you know, a ton of stressful things, whether that's, you know, chronic activities, like doing Iron Man, and your work is stressful, and you're around a high, a lot of high energy, high voltage stuff, or 5g may be a big problem coming up, who knows, you know, if you're around a lot of, you know, inflammatory food sources, and you're eating a lot of sugar and dairy and gluten, blah, blah, blah, then yes, you're not gonna repair as well, you got so many fires lit that your body is trying to put out every day and every night that you're sleeping, you'll never get to the end of the road on the repair cycle for that. And that's, I think that's certainly one of the biggest problems. And what requires a total team approach is, how many how many of those little cycles? Do we? Or how many of those pillars Do we have to repair to actually get you to heal? So the younger stem cells, are they more potent? Can they do more work? In the right setting, that's probably true. But can my cells do the work for me, if I concentrate them well enough, and get them in the right spots, if I deliver them to the right place? And give them the right nutrition and the right, you know, lubrication? With hyaluronic acids are all the different things we use. If I give them the right. graph, if I can help them in graph by putting in the right spots, and giving the right nutrition and everything else, the right energy, then they should work. So we don't you know, really the the embryonic sort of issue has kind of gone by the wayside. And that's a good thing. I mean, a lot of the even the religious hospitals, you know, institutions are certainly are proponents of adult derived cell use? And that's certainly their answer to embryonic uses. Let's use your own adult self. That makes a lot of sense.
Sure. So that was a little aside. See, we were talking about, you know, catching things early, before they become this huge issue. Right, you were talking about being in the classroom? And, you know, the kid. So
yeah, I think if we had the ability to teach about a systems biology approach, which we're getting much better at, you know, and I graduated from University of Missouri Columbia med school, and they use a problem-based learning format, which I know a lot of schools do. And so if we go and look at a patient who has a history, we'll just pick obesity and metabolic syndrome where they have, you know, cholesterol is that are high and their hypertension is high, and they have some early diabetes, you know, some insulin resistance, and maybe even thyroid resistance and all these other things. You know, if you go start picking apart those systems, and you think they're all just, you know, isolated systems, they're not. And so how do you, how do we teach people, including our students from, you know, even grade school that what you eat matters? And what you think matters, like how you think actually changes your outcomes? And, you know, your intention is reality, right? That's kind of used as a common saying, but certainly, we're seeing more and more, especially in these times with COVID, you know, a lot more depression and anxiety and all those things. And I think we're, we're losing the part of this, I understand is just, people are just trying to survive and get through their workdays and get through their school days. And, you know, we're just trying to make it through this crazy time of COVID and the pandemic. But even in the pandemic and looking at COVID. risks and who is getting sick with the virus. Most of those patients have chronic inflammation. At the base. And so I think part of that is coming back to where the money comes from for education where the money comes from, for new drugs and where the money comes. It's just about politics and money, quite frankly.
Right? And you know, it's hard to hard to conceive a grassroots effort that completely can out outwit and outplay those. Right, those factors. I mean, that is, it's hard to overcome.
Yeah, I mean, how are you going to beat the sugar industry? Or the corn industry or the right, you know, but I think that is happening in some, I think that's happening more in the dietary food arena these days than it ever has before with, you know, we certainly see, and I'm, I'm probably getting stories driven to me, because that's what I'm looking up. But I see, I see a lot more stories now about Mediterranean diets, and anti inflammatory diets and all kinds of, you know, inflammation, reducing lifestyle, things, whether that's meditation, or Tai Chi, or we use Wing Chun for movement, or we use, you know, there's so many things on how we know there's a mechanism how you move affects your epigenomics. You know, if you're moving well, then you're then you have less inflammation, we know that's true. If you're breathing Well, we know you have less inflammation, we know that's true. If you're eating well, we know you have less inflammation, we know that's true. And so I think that we need to make that more of a of a true knowledge, you know, base for everybody. And that's,
I mean, the common theme there is the inflammation. So still inflammation. Yeah, I mean, you know, when we were talking before the episode here, that was one thing that you've kind of emphasized over the last, you know, couple of years, you said that was kind of a newer thing that you've really Incorporated. So maybe touch on, you know, what is chronic inflammation, right? We've kind of talked about the hypertension, the diabetes, arthritis, all those chronic type of concerns, but where does the chronic inflammation come into play?
Oh, yeah, that's a, that's a big nugget. So I have a friend who describes it as kind of the monkey on your back. And every time you turn around trying to look for the monkey, right, you can't see it, because it's just, it's just on your back, and you can never look at it. And so, you know, the biggest problem with chronic inflammation for me, has been, I know, all these pillars exist, whether that's, you know, the, again, how I, how I think how I eat, how I, how my hormones are acting, how I'm moving in, as humans were always really good at focusing on on one, like, I can focus on getting my movement and my exercise patterns down, and then I'm like, well, then I let my diet nutrition kind of fall apart. And then so it's, it's really difficult to, to be able to manage all these things at once, like, every, everyone has a hard time. And with managing multiple, you know, baskets at the same time. So in lifestyle change is very, very difficult. You know, having eaten a certain way and grown up a certain way, you know, getting rid of sugar, or soda, or corn or whatever can be very hard. And so there has to be some support there, whether that's support your own family or support from, you know, local support groups, or your or your practitioner, your, you know, your, your, your whatever clinician, whether it's your primary provider, or whoever. And we just found that, unfortunately, that really was not happening in the primary care space, because quite frankly, physicians don't have time to talk about that stuff. It's so involved, and there's, you really have to dig down and ask each and each individual patient, not only which pillars are affected, so if it's hormones, or you know, again, stress or your movement patterns or all that stuff, but then you have to find it, and then you have to be able to do lifestyle intervention to fix it. And quite frankly, most physicians have, you know, the ability to spend five minutes with their patients. And, and that's all they can spend. And so these are very, very difficult to do in a traditional insurance payer model. And we found that we needed to give patients access to the different platforms, whether that's again, the movement piece or the functional medicine piece are those and But still in, in again, the it's not so much giving that initial in information it's then what happens if we hit a stumbling block? And you know, it's a it's a holiday coming up and thanksgiving and I want to eat stuffing and stuffing I know is going to make me inflamed right. So
how do I, how do I then get around that? And it's not like one of those things, you can just completely counteract it. Right? You know, you can't just take something that's gonna prevent inflammation for the day,
no Celebrex and again that that whole ibuprofen and non steroidal, whether it's steroids or anti inflammatories, nonsteroidals. I don't mean to keep picking on Celebrex, because it's a good medicine. Right? And when we're using it for the right, right, acute inflammation, yeah. But those are, like you said, those things can be difficult to counteract. And even you know, I think I truly believe in kind of that 8020 model, nobody's going to be perfect, we all have, we all have our ups and downs, there's always going to be stress in the world. And it's always going to require us to fall back on our, our known support, you know, whatever our habits have been in the past to help us get through times of stress. And, but you have to build a better toolkit. And our goal is physicians and, and therapists and trainers and, and I think is to help patients build a better toolkit. And unfortunately, the patient has to be actively involved in that, and not expect us to just give them a drug as their only toolkit.
And I think that goes back to that early catching too. You know, if you were, if the client was more involved, or the patient was more involved with that initial thing, they would have had it fixed before 15 years later, yes, you know, and that's and it kind of goes hand in hand that that small thing becomes a chronic problem over time, whether it's lack of care, or lack of knowledge, or, you know, a lack of stick to itiveness, if you will. And so it, it just kind of adds up when people and I don't think they realize how bad things are going until it's really bad.
Yeah, and a lot of the things that we think of is, you know, sort of benign or good like we in the West, I know we sit, we sit, I sit in chairs a lot we were trained to sit when we were five years old, in kindergarten, right, we were trained to, we were rewarded for setting through a day of school. I like the work of Katie Bowman, who's a bio mechanist I really love her work. And she talks about how we make our kids ninjas at sitting when they're five, right. And so in societies where they squat to toilet and prepare food, and they, they have the ability to keep that squat ability where they're not sitting in chairs all the time, they have a fifth of the incidence of knee arthritis and lumbar disc disease that we have in the West. So there's we know that you know, sitting is is is the new smoking kind of thing they talk about. But we also know that you know, prolonged standing in front of a in front of a conveyor belt and doing factory work is not healthy either all the time. So, you know, again, it comes back to that those tissues are designed to move. And that whole mechanism if you're not moving well, then you're going to get chronic degeneration and inflammation. So how do we as a society, change those movement patterns when we're on our cell phones all the time, and our shoulders roll forward, and you know, our pelvis is tilted, and we're used to sitting and our, you know, our, our gastroc soleus, and our calves get tight and our hamstrings are get tight and our butt muscles don't fire? Well, our breathing mechanisms, our breathing mechanisms get super restricted. And it's something as simple as that, I cannot tell you how many patients we because now we test everybody for fall risk, and we test them for movement screens and breathing. And 98% of the patients that we've tested, going on sort of a model backwards to where their movement patterns are clean, we have to go back and train people how to breathe again. And so kind of on this developmental pathway, you know, you come out knowing how to breathe, and then you learn how to roll over and then you learn how to crawl and you learn how to walk and then you learn how to run. And so most of our patients, we have to take them back to the breathing stage just to get their ribs moving, again, their diaphragm moving again, stop putting all this load on their upper shoulders and traps and all this stuff that you know that that we have this chronic stuff because again, we're sitting and we're on computers, and phones. And so something as simple as that can change, you know, your whole entire pain, you know, progression. And that's a very, very difficult thing to change when we're on computers every day. Right? That's like how we make our life. That's how we make our livelihood and our living. That's how our society is set up.
That's how it's built. Right? I mean, you think of St. Louis, how many folks are able to bike or walk to work, right? You talked about that variability of movement. That would help right we're sitting in the car, we're sitting at work, we're sitting at home You know, if we could bike or work or bike or walk to work, great, but I mean, it's hard in the suburbs, it's hard and city like St. Louis is so spread out. Yeah.
Again, it's money in politics, you know, you have to have the whole mass transit issues come into play. And and, you know, do you have access to green space? Do you have access to safe spaces to walk? And are you encouraged? You know, I think that there's a lot of the companies now are much more informed my daughter who's in her 20s, as a new job with a company who does support that. And I think that's, I think that is a company who has knowledge, either there with foresight, helping her build a toolkit that's responsible, or they know that if they don't, they have a lot of absenteeism and injury rates, you know, from people who have neck pain and back pain and all this stuff that comes with sitting at a desk a lot. And
right, whether they're looking at it purely financial isn't we don't want to lose, you know, and have a bunch of turnover and have to hire new people. And it's expensive to hire new people, or if they truly care about how their people feel, doesn't matter. Why, right? But as long as they're doing it, and people are happier, then that's a good thing.
Yeah. And if they're, if in ultimately, if my daughter who's 20, doesn't have the chronic other, again, those those pillars, whether or not it's metabolic syndrome, or whether it's, you know, that her microbiome gets messed up, or whether her mechagnomes stays healthy, you know. And if we could do that, with more foresight, with I think it's, again, it probably has to happen in the younger age group. Because I think the older population, we're putting out fires and dealing with limitations in joint movement from a knee or a hip or a back or a disc. And the people who still have the ability to, to change things before they get really ingrained, you know, sort of that earlier half of the curve. I think that would be the the the ultimate population to affect change, right. But our society doesn't do that.
Not at all. And you know, I'm reading a book right now, and I'll keep it private for now. But there's a quote, and it says, You need to habilitated before you re and it's kind of funny, finally, you know, finally worded but like, it's true, you should, you know, fix the habits fix the problems before they become a real problem. Yeah, yeah. Like you said, putting out fires, I mean, that's, it's exhausting.
That's what I do all day. Right?
It'd be lovely to work with someone who's like, I'm here for my yearly physical therapy screen, so that you can teach me how to move for the next year things, I need to focus on things I need to work on at the gym, I need to work on it work,
what are my movement liabilities that I can? Correct?
Exactly, exactly.
And how is that? How do? How can I as a solo practitioner, you know, create that model? When nobody else in St. Louis is doing that.
That's tough. It is very tough. And I think patients are hearing it more and more. And I think when patients it's kind of one of those things, you have to experience it to get it. So they're like, you know, it's hard for people to grok it is that a term that you used like IATA rocket, which means I, I can totally wholeheartedly understand it and get behind it. And so if I'm going to totally get that knowledge ingrained, I have to have the experience of going through it. Like, I can't just tell you, hey, Greg move better. Right? We have to be able to say your butt's not firing, right?
You can't just read an article that says, Oh, you should move more. And yeah,
you can, this is how you should breathe, right? Get your ribs to expand sideways and and you know, like a crocodile laying on the ground or get your diaphragm to move or, you know, stop throwing the energy up through your, you know, turn up to your shoulders and your traps and the base of your skull. like, Alright, I'm gonna concentrate on that. And so how do you do that, and that, that's the unfortunate thing is it takes a lot of practitioner time, and feedback, you know, changing those feedback loops to break that cycle. It's almost like a 12 step program to be quite honest. And, and very similar in that you need, you know, you're gonna take two steps forward and one step backwards, and sometimes two steps backwards, and then two steps forward again, and it's never, you're never going straight up the mountain, right? You're just up and down and up and down. And it's frustrating as all get out.
But it all comes down to, to habits. Yeah. And how willing the bad habits, you know, setting good habits because you can't really truly break a bad habit. It's just forming a new habit to replace the bad one. Yes. So it's, you know, and you have to be willing, I
always say like, if you're not willing, or you maybe and that's a hard thing, because sometimes when you're super stressed, I'm not willing, like if I'm not if I'm super stressed and I want to eat, you know, thanksgiving stuffing at, you know, at Thanksgiving, then I'm gonna eat the stuffing. But then I better have a toolkit or somebody to be able to help me get dig it. You know? Dig myself out of the inflammation that it causes. I mean, for my own practitioner to level, like, I can't tell you how many patients, for example, in regenerative medicine, and this is what got me into this, you know, I'd have patients that come to me that were were more enlightened than I was. And I'd maybe get 50% improvement in pain and function off the stem cells are off the prps. And they would say, Alright, I'm 50% improved, but I'm going to try this, you know, anti inflammatory diet, I'm going to either, you know, choose gluten, dairy sugar, I'm gonna get rid of those or do Mediterranean or, you know, get my movement patterns back. And I stopped counting on my my hands and toes, right? Because there was just more patients that I could count that actually changed their pain from a 50% improvement, to 80 to 90% improvement in payment function. And I'm like, wow, there's something truly behind that. And so we want to support that in the patients. It's just very difficult even for us, when we're doing regenitive medicine to take the time then to go, okay. You know, here's all the different, here's all the different pillars, and we can connect to you, which I think is a connection thing again. And that's why it's great to have these podcasts and connections like yourself, where we can say, hey, Greg GDS is going to be, you know, helping you with this section of or this portion of what you have going on. Because people really do need that. And, again, part of the problem is, you know, how much time effort and money do we have to spend on these problems? When life is going on around us when we have all kinds of things?
Well, it kind of goes back to your point of if the primary care physician only has five minutes to spend with you, but they want to talk about chronic inflammation and diet and lifestyle and habits. Okay, so they got two options, either they can refer you out, but they haven't had enough time to explain why they're referring you out. Or they can hand you a gigantic stack of paper and assume that you're going to read it,
which never happened. We know that that's true. It's red. Right? Right. Right. So
what you know, what benefit is that really providing how, how many of those folks that are treated like that are proactive enough to take 10% of that and and really go for it?
Well, yeah. And the problem is the people who are motivated by that are already the people who are sick enough that they're down in the, you know, they're down in the dregs of you know, they don't, they're hurting all the time, and they're depressed, and they're anxious as heck. And they are, you know, they're having chronic disease problems, whether that's diabetes problems, or heart disease problems, or strokes, or, you know, they've already gotten ALS, or they already have dementia. I mean, I can't tell you how many patients I've seen over the years where we're working on some chronic degenerative condition. And the family members will ask us about whether it's early dementia or those things. And there's once that stuff is I was, you know, say once the horses out of the barn, it's really hard to get the horse even back to the stables, let alone back in the barn. And so, returning that chronic inflammation to some low burn rate is much, much easier if you catch early, but like you said, most patients, our bodies are incredibly, incredibly wonderful. This is one of the things I love about medicine, is we are so adaptive, and we can humans can tolerate literally so much. Until the system breaks. And when it breaks, it is a it is a it's a it's a big big problem at that point
masters of compensating Yeah, that's what I usually call it. It's because you know, someone can, you know, sprain an ankle, and walk on it for 45 years until they have chronic back pain, knee pain, hip pain in a you know, they've got this one issue that turned into a system wide issue.
And I've seen it on myself. I mean, again, I have some there again, I'm a loosey goosey collagen type. But I think, you know, I hear that sort of phrasing from a bunch of physicians in the bigger sports medicine fear these days, whether it's Harvard or you know, Andrews are the guys in the, in the sports world. And so we're learning about collagen, you know, you kind of were given your own collagen type from your mom and dad's collagen, whatever types they had. And certain things will help keep that collagen, you know, healthier than other things. But every human is going to have collagen that regenerates I mean, unfortunately, you know, saggy skin and all those things are gonna happen to all of us. And joints get looser and all those things. So how do we optimize for, you know, our age? And I think that's a I think that's an individualized, you know, number whatever. But I think there's ways as practitioners that we can help a lot of people understanding again, if if we had a way to, to have those going back to your example of the primary care provider, to be able to pay those primary care providers for actually spending the time or have a group of individuals that are supporting that primary care provider. In giving the patients that that that total team approach or that network of, of clinicians or therapists that can actually help the patient understand, this is what we're working on today. And we're never, we're never going to stop working on, you know, your metabolism, how you how your body metabolizes, you know, energy. But you're not going to focus on that forever. And then, you know, do we have to work on your hormones for a while? Or do you have to work on your meditation for stress relief, or whatever you're using for stress control. And unfortunately, that was a thing that I was into. It was chronic exercise, like even, you know, chronic exercise. If I had to go back, I'm 53. Now if I had to go back and do things over again, I would have changed how I recovered from exercise and change my chronic exercising patterns, that going through med school in a stressor residency and all of life.
Are you here forever, that exercise is a form of stress relief?
You know, it totally is. And unfortunately, it's, it can be an abnormal form of stress relief, which a lot of our, you know, chronic endurance athletes are over exercisers certainly are using it that way. And I think that's another sort of habit that we've built that is super sly. You know, I, I have a lot, a lot of patients who say, you know, when can I get back to running? Or when can I get back to tennis or when can I and if we, if we want to take them if we need them to take a month off, or six weeks off, or even a season off? That's, that's unacceptable to a lot of patients? Well, I
remember being in your office shadowing. That was the first question on the first client. And I think your statement was, Well, the reason I'm doing this is because I had knee issues, and I don't run, you know, right. And so you were basically kind of putting, you know, dropping the hammer a little bit like, you can't do exactly what you want to do. Yes, you can be functional. Yes, you can do and be active. But, you know, running ultra marathons, maybe we're just doing 15 case or something, you know, and it's trying to do things in moderation.
And it's figuring out that repair site if I can, if he can run a five K and recover excellent. If he can run, you know, if we can only do longer hikes and very short, Sprint's fine, you know, we have to find some other outlet for people. And certainly the world is a very stressful place. And we all need our stress relievers. You know, besides the the abnormal hard ones, like alcohol and drug dependence, and all the other things, unfortunately, they're going up to an exercise seems like a very healthy response. But there certainly has to be a better. There's this, there's this thing that we're using in the beginnings of developing, it's called the regenerative metrics index, the Rmi it's called. So how do I tell if a patient's tissues are, are the best we can try to make it to heal? Like how do I tell if you know, my knee, if I put cells in there, when that healing is adequate, or good enough, or it's gonna kick in the cycle again to do with repair, so it turns over every two years like it's supposed to? Or will it just keep degenerating? And this is kind of coming back to that inflammation. thing, like I always think of chronic inflammation now, and I can make that inflammation go quiet or quiescent. For years at a time, typically, with stem cells and regenerative medicine, I can make that inflammation go quiet. And this is like hypertension or diabetes, you know, only it's in your joint. So if I if you have hypertension and diabetes, you can't make it go away. But you can certainly control it and keep it quiet. So it doesn't eat the nutrition from your blood vessels and cause heart attacks and strokes and things or kidney disease or your eyes to go bad and all those things in your joint that chronic inflammation choosing nutrition from the cartilage because it's not repairing. So how do I make that chronic inflammation, go quiescent and hold it quiet. You might I might flare it up again. And that's probably that's usually what happens over a period of years. I like even joint replacements last 12 to 15 years, the joint replacements aren't permanent, there is no permanence, right, impermanence is a human trait. But how do we not really talk about permanence, but the repair cycles in and you know, keeping chronic inflammation quiescent in cellular repair optimized, super, super tough. And there's certainly a lot more thought going into it around the entire globe. And there's some you know, even older, you know, things like cupping and acupuncture have made big comebacks, because they do help with that. So there's always this kind of idea of how many things do you have to throw in the pot right to make it not only throw in the pot, but Take out of the I always think of the blender, right? There's this big ingredient list in the blender. There's usually not one ingredient in the blender, humans aren't that way. How many things do you have to take out of the blender to kind of get to an idea of what's actually causing the problem? What's actually making your pain, your pain? And then how many things do we have to repair to make it go away? You know, not for short periods of time, like three months, like a steroid, but forever. And that's a that's obviously where, you know, really good. clinician providers. That's, that's why we make our money and do our do what we do, because we love it.
Absolutely. And, and that kind of leads into something that you brought up earlier, that total team approach is because sometimes you may realize that, yes, there are a lot of different things that need to go in that blender, but that may not be your specialty. Yeah, so that's where getting some help from other providers is crucial. So how do you use that total team approach in practice right now?
Well, we're getting, we're getting better and wiser edit, you know, we have movement specialist, and we have therapists that we trust. And we have, we do fall screens, and I have a whole fall training program on how to how to teach people actually how to fall down and get back off the floor. And a lot of these were based on my own family, my father had a really horrible spinal stenosis and spine degeneration problem he's got, I got my arthritis from somewhere, right, my family history. And so for my, a lot of these things, I had to build for my own family, I have a big family shout out to my big family all over the, you know, mid Missouri, area, and, and a lot of them have arthritis. And so I end up seeing them and trying to solve problems as best we can, without, you know, some of them had to go out and have joint replacements totally fine. If we can hit them early and keep, you know, surgeries to a minimum. Great. And so using all the team approaches, whether that's functional cardiology or functional gi providers, or, you know, therapists, good physical therapist who are engaged in not just working from an algorithmic protocol driven, you know, knee rehab cycle or shoulder rotator cuff cycle. The problem with physical therapy is kind of like medicine, like, you're only paid for working on the shoulder. But it could totally be related to your pelvis and core rather than your shoulder. Right. And that's,
I mean, that's the beauty of my practices. You know, I'm private pay. And
so you get to focus on the whole entire Yeah, exactly. And so
when people come in for their, their shoulder pain and their hip pain, and we're working on the ankle on the first day, they're usually pretty concerned, but when they feel better the next time they get it,
yeah, exactly. Right. So I think that's kind of the model in a nutshell, for the total team approach. And it's, it's really difficult to find, again, practitioners, whether it's nutritionist or whether it's, you know, even rheumatology, for example, or let's pick some others, you know, specialties. It's, it's hard to get everybody on the, on the same. It's hard to have everybody sort of focusing on the patient in and helping the patient figure out what's top tier, middle tier lower tier, like, I, no matter what, I can't let go of that, of that particular, you know, ball in the air, because that one is critical to me getting better. But we can certainly work on all these other, you know, areas. And there's always there's no best I always say only better, right, we can make things better, better, better. There is no best if we were best is when we were you know, eight years old, running around like bananas. But we all have some, you know, some things that we could work on whether that's taking time out of sitting and getting off of social media. I'm, I am not a big social media fan. And podcasts are great, though, by the way. Shout out. Yeah, shout out. But I think that there's a lot of energy that we spend in the wrong place.
Yeah, there's a lot of negative energy. Yes. You know, and it's, there's not a whole lot of, I guess, what it was originally created for, which was, you know, camaraderie being able to stay connected. Well, there is that, but it's the secondary to spewing nonsense. And yeah, you know, and vitriol,
exactly. But going back to your total team approach, I think it's something that I am getting better at, as, you know, we all as we age, I think we learned that we don't have the answer The answer.
And that was going to be my question is, it seems almost impossible to get everyone to, you know, we kind of talked about the the box that you guys fill between surgery and, you know, PT and everything else, right. How do you get people to, you know, fit into the right entry point. You know, if someone if someone comes to me, but they're more appropriate to work with you. How does that there seems like there needs to be like a central evaluator almost that can place people where they need to be at It's, it's hard because you know, we don't work in the same office, like how do your people know they should be seeing me how to my people know, they should be seeing you or, you know, somewhere else along that continuum. I
mean, that was the original when I was a med student, right, that primary care providers that was supposed to be their goal was to be that, you know, that gatekeeper. And it never really worked out, quite frankly, because of payer models. And, you know, I'm getting paid, you know, $38 for an hour visit, and I'm not going to keep the lights on and keep my nurses employed for $38 for an hour visit, it's not going to happen. And those are real Medicare reimbursement numbers, you know. And so, the primary care providers are like, Well, Jesus, I have to see, you know, basically eight or nine people in an hour's time to be able to even keep the lights on. And so I think that's a great question. And and I think people do find it, I think that people, like patients who are really good at it, have developed sort of their own network, and, and they've usually learned from other patients, quite honestly, more so than other providers. Just because they have acquaintances, or neighbors or friends, who've kind of had the same issues, whether it's, again, hypertension, diabetes, or you know, joint disease, back pain. And they said, Oh, I went through that. And here's how, here's, here's who I found really help. And we're almost all word of mouth at Blue tail, we don't advertise a lot. And all of our word of mouth, from different states and places around the country of the world, have just been because we've helped patients. And I think that's one thing that separates us from a lot of other clinics is we won't do cases on patients where it's inappropriate. You know, probably about half the patients we see are not good candidates for general medicine, quite honestly. And 50% of patients are good candidates. But most of those patients, again, we're gonna put every one of them through a movement screen, or Pol screen, and we're gonna check, you know, we're gonna check labs, at least a basic lab panel, just if your vitamin D is tanked, we better fix your vitamin D, because we've learned that that's a problem for healing, just as it's a problem in the COVID area, if your vitamin DS are low, you're likely to be more sick. So, again, inflammation is inflammation, don't care if it's a new joint, or in your, you know, in your person. So I think that that's a great question. And until the payer models change, or we have a better way to engage patients on again, more education and younger age groups where kids high school college, are coming up. And there are a lot more, for example, D one D two schools now where those kids have access in the sports arena, especially where they know that, you know, they can use cryotherapy, and they can use kinesiotape, and they can use laser, and they can use, you know, all those tools are pretty much available to the athletic, athletic population. But I wanted to available for, you know, the science geeks to? And how do we do that? That's a societal question, in my mind,
right. And I mean, you know, creating the perfect clinic that can do everything, it's almost impossible. Yeah, to get everyone to play nice together, and, you know, fit the whole mold and
provide it have to be subsidized. And you'd have to have a lot of, and those those, you know, industry sponsors and industry support is getting better and better. And again, I think you have, I think you have some industries that are more aware. But let's be honest, humans are still humans, and

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