Podcast Drop Date: 1/11/23
David Musnick is a board-certified medical doctor who offers Functional Medicine, Sports Medicine, Functional Immunology, and Primary Care for adults and teenagers. He specializes in sports medicine, internal medicine, frequency specific microcurrent (FSM), scars, homeopathy, prolotherapy, and low-level laser treatments. Dr. Musnick has more than 24 years of experience in Functional Medicine and achieved a very high level of both experience and expertise with many health conditions. He is also the author of the book, Conditioning for Outdoor Fitness, and helped in writing textbook chapters on arthritis and concussions.
In this episode Dr. David Musnick, MD discusses the following topics:
How scars cause pain
How a scar affects the strength of a muscle, range of motion of a joint, pain and pain processing
How a scar affects the function of the gut, heart, lungs etc.
Can a scar limit healing?
How do you know if a scar is a problem and needs to be treated?
And so much more!
To be seen by Dr. Musnick, contact the Eagle clinic for further details or to schedule an appointment: FMI Eagle Clinic 435 S Eagle Rd Suite 100
Eagle, ID 83616 Hours: Monday-Thursday: 8am-5pm Phone: (208) 260-5431 Fax: (208) 385-0346 Email: info@funmedidaho.com
Amber Warren, PA-C: Welcome to Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper. Hi, everybody. We're back here with Dr. David Musnick to talk about scars and problem therapy. Dr. David Musnick is a board certified medical doctor who offers in-person and telemedicine care from the Functional Medicine of Idaho Eagle Clinic. Dr. Musnick offers functional medicine, sports medicine, functional immunology and primary care for both adults and teenagers. He specializes in sports and orthopedic medicine. Internal medicine frequency, specific microcurrent scars, homeopathy, pro therapy and low level laser treatments. He has developed a unique program to heal the brain after concussion that integrates diets, diet supplements, sleep, exercise and microcurrent and brain training to heal the brain. After concussion. He applies this to other brain based disorders, including cognitive impairment and dementia. He has a special, special interest in autoimmune disorders and has studied functional immunology. He's one of the top ten clinicians in the world with frequency specific microcurrent and he teaches at Microcurrent meetings. He's very experienced in pro therapy, regenerative injections to build more ligament to stabilize a joint or area of the spine. After his internal medicine residency in Seattle, Dr. Musnick completed a fellowship in sports medicine. Dr. Musnick has more than 24 years of experience in functional medicine, and he's author of the book Conditioning for Outdoor Fitness. And he's also helped in writing textbook chapters on arthritis and concussions. Dr. Musnick received his Doctorate of Medicine from the University of California, San Francisco. He is certified through the Institute for Functional Medicine, and he also has studied in the French School of Homeopathy. And we couldn't be more thrilled to have him on our team in 2022. So let's start the conversation talking about scars. So let's just dive right in. How do scars cause issues cause pain?
Dr. David Musnick, MD: This is really an under thought of thing by most doctors. So scars First, let's talk about how people get a scar. They can get a scar from, of course, having a surgery. The surgery can go fine, but the scar can still have problems in the body. I'll explain that. They can get a scar from a burn. They can get a scar for immunization. They can get a scar from a bruise. Like an abrasion that there are internal scars. They're called adhesions. So scars can cause problems in a number of ways. One. The scar can hurt. Two. The scar can have a pulling effect on something else called a facial restriction. So you could literally have a scar in the abdomen that is affecting the shoulder. You have a scar on the abdomen that's affecting the back. So scars also can affect muscle strength, which is really fascinating. And that's really fun to test on physical exam. And the medical assistance we have at the Eagle Clinic have been like their eyebrows are like, Really? Yeah, really. This is. And then you can demonstrate it right after the treatment. Now, these muscles are stronger. The other thing scars can do do is increase pain other in other parts of the body. That's called pain sensitization. So they can be a they can be something that precipitates chronic pain or that just contributes to it. Then scars can affect internal function. So scars can affect like a scar in the abdomen can affect gut motility and gut function. Scars over the chest can affect the heart in the lungs, so they can affect internal function, too. And that's probably a good summary of what what what they can do in the body.
Amber Warren, PA-C: So the way you're describing a scar, you don't have to physically see anything externally.
Dr. David Musnick, MD: Well, yes, for the external scars. So most of what I'm talking about now are the ones you can see. There's the adhesions that are most common after abdominal surgeries that can cause problems because they're almost like blocking the motility of the gut. So so that would be called an adhesion. But mostly I'm talking about the ones that are on the surface that you can see are probably the can be the most problematic.
Amber Warren, PA-C: But so a lot of people are affected because how many people haven't had some kind of procedure, surgery, some kind of injection doesn't necessarily have to be a vaccine. It can be a b-complex injection.
Dr. David Musnick, MD: What if you had a biopsy? Yeah, patient has a biopsy and like of something, even if it was benign and that scar can cause a problem, I mean. I could tell you story. I mean, I'm probably treated 5000 scars in my career. But I tell you story after story about how this occurs. And sometimes, you know, they're having a problem now. But the scar was from seven years ago.
Amber Warren, PA-C: So that doesn't the issue doesn't have to happen right away.
Dr. David Musnick, MD: No, it doesn't.
Amber Warren, PA-C: Years later. Yeah. So interesting. So how specifically does a scar limit healing in either that area of the body or another area of the body?
Dr. David Musnick, MD: Well, there's different theories. So I actually wrote a book chapter on this, and it was supposed to be published in a book called The Trigger Point Manual. But for a long story, a lot of chapters never were published in that book because the editor passed away. So I spent a long time putting these theories together. So one way, if the scar sends out aberrant signaling to the spinal cord in the same sections that muscles are supposed to be controlled, that scar can be affecting muscle strength. That's called recruitment. That's very common, actually, where something is weaker than it should be. It's just not recruiting. Well, if a scar actually there's a theory and a lot of acupuncturists will agree with me that if the scar goes through an acupuncture meridian, it will block the meridian partially or fully, Probably not fully, but it will block it. And then there's the fashion pull theory, where the fascia organs bound up around the scar. So there's a lot of reasons why scars can cause a problem. And the other way is if it's a keloid. So a keloid scar is this thick red scar that is.
Amber Warren, PA-C: Going to typically.
Dr. David Musnick, MD: Raise raised thick red. The keloids are usually uncomfortable. Some people produce them more than other people.
Amber Warren, PA-C: Why is that? I've heard a lot of different theories on why people.
Dr. David Musnick, MD: Well, there's a lot of people that will tell you that the ones that do it, they have some issues in their immune system, so they produce more what's called they have more collagen and fibroblast development more than the more than like, let's say someone has a surgery and they only need a certain amount of of a scar to close off after the surgery or they get a cut or something. They produce way too much and it turns and then there's all this increased capillaries and blood flow and. So there's different theories as to why that occurs. Often people will tell you it runs in their family and they're more likely to have more than.
Amber Warren, PA-C: One of them. Right. And is that true for the adhesions under the surface as well? They're more likely to recruit the.
Dr. David Musnick, MD: Yes, Yes. But a lot of people can have adhesions. They don't even know about it. You know, like they had an abdominal surgery and then they have motility problems or gut problems or because there can be adhesions in the gut.
Amber Warren, PA-C: And it might not be. And this is where I love functional medicine. It might not be just the adhesion that's causing an issue, but it could be multifactorial and that could be one thing that's really limiting one's ability to.
Dr. David Musnick, MD: Heal.
Amber Warren, PA-C: In regards to gut health or healthy.
Dr. David Musnick, MD: Well, that brings up a really important point, which I like. When I teach functional medicine and other docs, I like to talk about this thing called points of leverage.
Amber Warren, PA-C: You do a great.
Dr. David Musnick, MD: Job, but this is what is one thing that we could work on for you that would have the biggest effect in helping your body get better.
Amber Warren, PA-C: Yeah.
Dr. David Musnick, MD: And I would always say, you know, because what I do with my patients, I do something. I talk to them about staging. It's not just like you got this and you need that or we're only going to do this. It's like, okay, let's look at a timeline on what we're going to do. But oftentimes in healing pain or orthopedic things or gut things or whatever, I will assess the scars and I'll say the first part of your treatment is going to be treating these scars. And then after we get done with that, then we're going to move on to this. So that's staging. But I find profound benefits from doing it, you know, and I don't treat every scar in everybody's body. I test them. I take a good history, but oftentimes they're related to their current problem. It may not be the only thing, but it's often one of the big factors.
Amber Warren, PA-C: Okay. So you say all scars, not all scars might be causing issues. So how do you evaluate that scar and know if it's problematic?
Dr. David Musnick, MD: So one thing I this gets into some interesting material. I say so. So it turns out that scars that are related to a traumatic incident. Have a storage of emotions in the limbic system in the brain. And those have been determined to be some of the most significant scars that keep acting up. So if someone had a surgery, was something was going on in their life that wasn't good or they didn't have support or they were, you know, oh, what if they didn't like their surgeon or the surgery didn't go well? I mean, there's all these emotions that go in there with that scar. So those scars often become persistent issues in the body. That's called sort of the limbic system, emotional aspects of some scars. Then Keloids are almost always a problem, Those thick ones. I take a history and say, did you develop any problems within one year of this particular scar? I remember years ago this lady said, you know, I had a C-section scar. Within five months of that, my back started hurting my next hurt or hurting and she had chronic pain at that point. And so I assessed that treated that the neck pain in the back pain went away. I mean, you know, sometimes it takes other things to it might take physical therapy or some other stuff, but this was a big deal. So these are often factors in people and oftentimes nobody asks about it.
Amber Warren, PA-C: Yeah, and I love the example. I love your points of leverage discussion, but it's also we talked about like the legs on a stool, right? Maybe a stool might have four legs and you've taken care of three, right? Maybe you've manage the stress, healed the adrenals, maybe you've balance the hormones and fix some nutrient deficiencies. But if that if there's still one leg that's problematic and it might be a scar adhesion, that's you can't you know.
Dr. David Musnick, MD: It depends how big a factor it is. But I'll tell you. People ask me, Hey, what do you think of some of the biggest interventions you're going to do that are going to help people heal? I mean, one of those would be scar treatments.
Amber Warren, PA-C: Interesting.
Dr. David Musnick, MD: And because it's a big I have found it to be a big factor. And maybe that's also because for a lot of these people, the emotional stuff is a big factor that got stored in there. And the limbic system is still acting up. And then because whenever I treat a scar, I ask people to talk about stuff.
Amber Warren, PA-C: I've seen you do it and.
Dr. David Musnick, MD: They just some sometimes what you hear is like, you know, I always have a box of Kleenex in the room and just like, get ready to hear it, because sometimes it's very interesting material that, you know, that needs to be unloaded.
Amber Warren, PA-C: Can you define the limbic system for our listeners and viewers?
Dr. David Musnick, MD: Yeah. So the limbic system is deeper in the brain and it consists of a bunch of different parts. And it's really I mean, it partially consists of the hippocampus, which is a memory center of the brain, but this is the limbic system is related to the memory center, and it's like stored emotion, stored emotions. So the limbic system is like stored emotional memories, but it affects things in the body, like the sympathetic nervous system can be hyperactive in people with these kind of issues. That's why there's so many different limbic system treatments out there.
Amber Warren, PA-C: So do you find that combining some of the limbic system treatments that we recommend with the scar therapy, sometimes those really go hand in hand to provide success?
Dr. David Musnick, MD: Absolutely.
Amber Warren, PA-C: So you're always recommending if there's emotions tied to a scar, adhesion, you're always recommending some of the brain rewiring distress program, those different kind of.
Dr. David Musnick, MD: Yes and no. Oh, because I want the ones that are the easiest for the patient. So what I usually start with is tapping. And we actually have one of our health coaches teaches people to. But I just find like that whole thing about tapping acupuncture points is very effective, that the whole theory is it helps the limbic system. It's quick and I think it's easier to learn than Dre's or the Gupta program. I mean, certainly if people need that, I'll recommend those things. But that's one of the first things I recommend. Great. Along with treating the scars.
Amber Warren, PA-C: I love that. So let's dig into treatment. What kind of treatments do you do for the different scars that you.
Dr. David Musnick, MD: It depends who the patient is, and it depends where the scars are.
Amber Warren, PA-C: Okay.
Dr. David Musnick, MD: If they're a kid. I almost never inject them. I'll treat them with laser or frequency specific microcurrent.
Amber Warren, PA-C: Because just the trauma of the injection.
Dr. David Musnick, MD: Yeah, yeah, yeah. I mean, the the scar injection is a gold standard, and you do it with local anesthetic, like lidocaine or protein or something. So that's what I do with adults. And it's a tiny needle. Yeah. I mean, it's, it's a 30 gauge needle. The funny thing is, with needles, the higher the number, the smaller it is. So the gold standard is injection with local anesthetic along the whole length of the scar. And that that's that's a whole field called neural therapy. And you are al that originated in Germany many, many years ago. There's there's whole courses on it whole Alice's about it. So that is the gold standard and that's my preference because you do it in like you do the first one and then you do the second one and 10 to 14 days along with the emotional technique. And then it's done usually unless it's a keloid. But for kids, then we'll use the laser or microcurrent or both. If it's on the face, it depends where it is. Okay. One of the most interesting thing about score injections is that it can have a cosmetic benefit. But since I'm not a cosmetic dermatologist, I don't push this. I don't. But I tell people, you know what, the scar could be more difficult to find, but we're not doing it for that reason, right? Therefore, some people want it for that reason. And I would say you need to understand I'm not doing it for that reason. But there are some areas in the face that I can do. I mean, I've gotten very fine tuned with this so I can do it almost people on their face as a cosmetic thing. But we're still not doing it for cosmetic things, like I'll do a scar in the face for headaches, something like that, but not for a cosmetic outcome. Or if the scar hurts, do it for that reason too.
Amber Warren, PA-C: So to scar injections 10 to 14 days apart. Yes. What about if you're going to use frequency specific microcurrent? Or that scar? How many sessions?
Dr. David Musnick, MD: Well, this is interesting because the reason to use that would be if I think it's got deeper scars below the surface. And that's where it gets into your question about adhesions, because people can have adhesions not only in the gut, they can have it in over the musculoskeletal system, sometimes two or three visits for that. If I think they've got the adhesions, but if I'm going to just treat a scar with that. I'll probably do a combination of laser and microcurrent. Two sessions, 2 to 3. It usually requires more sessions than injection.
Amber Warren, PA-C: I'm kind of a definition person, so frequency specific microcurrent. Can you define what that is and how that helps the body?
Dr. David Musnick, MD: Yes. It's my favorite three letter word.
Amber Warren, PA-C: Well, it's.
Dr. David Musnick, MD: A blood brain barrier.
Amber Warren, PA-C: I know you have a lot of them.
Dr. David Musnick, MD: It's abbreviated FSM. Yep. It's a different type of microcurrent than all other Microcurrent treatments out there. So in Microcurrent treatment, there's an eight channel, a, B Channel or Channel one and Channel two. The more current nomenclature is Channel one and Channel two. So Channel one is a frequency that deals with a condition like inflammation, which is 40 or scarring which is 13, or calcification which is 91. Mm hmm. So there's a there's a channel one, but the B channel is the tissue, like the nerve 396 or the blood vessel capillaries 162. So. Frequency specific Microcurrent combines not only a Channel one and a Channel two frequency, but the right sequencing of when those pairs need to be ordered because you just run them round randomly and the right amount of time and at the right microcurrent to treat something. And the interesting thing is the best way to do it is to treat the nervous system first and then to figure out all the tissues that have the issues and use the microcurrent programs to treat the underlying factors. Like it could be a scar or it could be other things you're trying to treat. Like oftentimes, if I'm treating a scar that has deeper scarring than just the surface, I'm going to treat a nerve, too, because the nerves can get scars around them. So then, for instance, one of the frequency pairs might be 13 for scarring and 396 for the nerve.
Amber Warren, PA-C: Interesting.
Dr. David Musnick, MD: And then in order to make it work even better, you have to apply a little bit of motion to the area and then the adhesions dissolve.
Amber Warren, PA-C: And you're using this microcurrent for so much more than just scars. And like talked about in previous.
Dr. David Musnick, MD: Episodes, we're using it for neck problems, any kind of brain problem, any kind of orthopedic problem, healing tendons, healing joints, healing nerves, healing disks, neuropathy, healing the vagus nerve issues, healing the gut, healing the barriers like the blood brain barrier and the gut barrier, SIBO. So many things, so awesome.
Amber Warren, PA-C: So back to the scars in the adhesions. What kind of outcomes are you looking for? What are you hoping to see if you feel like you're, well getting where you want to go?
Dr. David Musnick, MD: It depends what the patient presents with. If they're presenting with pain, I want the pain to go way down or go away. If I think the scars are affecting muscle spasms and trigger points, then I want to treat the scars and have those muscle spasm trigger points go away. I want the muscles to get recruited so they're normal. I want to take away all the issues that the scars are causing in that particular patient. And so. It really depends on what that patient's presenting with, because sometimes they're not coming in for the scar. They're coming in for this pain, that pain, this pain, that pain. And so I'll decide whether I think the scars are going to be like a point of leverage. And oftentimes they are.
Amber Warren, PA-C: So you have a ton of experience in scar injections, kind of treatment modality. How have you been able to fine tune your technique along the way?
Dr. David Musnick, MD: Well, I decided a long time ago that the tinier the needle, the better. I used to use a 27 gauge needle and, well, it's a little bigger than a 30 gauge needle. I even used to use a one and a half inch, you know, try to thread the whole thing in there. The crazy thing, it turns out the most comfortable needle for people to experience is a 30 gauge half inch needle. And I even used to use the 30 gauge one inch needle, and it was too hard to thread in there. And so then there's a there's a needle technique called a bent needle technique, where you actually bend the needle in the sheath and thread it in and inject while you're going in and going out. So I sort of developed this over the years.
Amber Warren, PA-C: Really cool. Any other benefits of these injections, these scar injections you're doing?
Dr. David Musnick, MD: Well, they increase they can increase muscle strength. They can they can decrease back pain, neck pain, headaches, decreased pain in general. And. Yeah. I mean, I have one patient. I've had a lot of patients like this when I just say I had a patient in the past six months that had a lot of scars on her belly. Some of the worst scars are tummy tuck scars. They cause havoc in the body. They might be used to, like, tuck the skin, but there's a lot of people with those scars that are having a lot of problems. She was severely constipated after two scar treatments. She was having bowel movements on her own, no laxatives. So it can affect things like that. That's like gut function, improving gut.
Amber Warren, PA-C: Function, right.
Dr. David Musnick, MD: I've had people say their breathing was easier. You know, I had a lady with a thyroid scar who had like 50% of range of motion of her neck. And then we she had actually had a thyroid scar and she had a C-section scar. She didn't want to do the C-section scar initially. So we did the thyroid scar and she gained about 20 degrees just from that, just sitting there. And then we checked her C-section score and said, I think we can give you more motion. And then did that. And she's got full range of motion that's on her neck.
Amber Warren, PA-C: That's cool.
Dr. David Musnick, MD: You didn't even touch her neck.
Amber Warren, PA-C: So a lot of people listening are probably like, goodness, I've had that procedure. I've had this mastectomy on my knee. How do they know if they'd benefit from maybe scar injection, scar treatment?
Dr. David Musnick, MD: Well, they probably need an evaluation, like a consult visit, but, you know, they probably have some symptoms. They want to be helped with.
Amber Warren, PA-C: Some kind of ailment.
Dr. David Musnick, MD: Yeah. Because I don't know that I'd say everybody would. Scars needs to be evaluated. You've got to have some something going on. But I'll tell you this. If someone says I want to be really healthy, can you just check these out? Yeah. It's probably not a bad idea to treat them. Yeah, there's no major side effects.
Amber Warren, PA-C: Do you see? Scars? Are adhesion increasing your risk of injury.
Dr. David Musnick, MD: Yes. How so? Because. Well, what if someone's not recruiting their abdominal muscles in their core? The most common weaknesses people have around their hip girdle and their butt. And so if you get those things working, they're less likely to fall. So, yeah, the scars can contribute to that. And treating them can lead to less risk.
Amber Warren, PA-C: Yeah. I love it. So let's move on and talk a little bit about pro therapy or hyper mobile joints and tendon. So Hypermobility, can you speak to just that general term?
Dr. David Musnick, MD: Yeah. So that's excessive mobility of a joint or joints. But it's often associated with other issues like people can have. Changes in their skin like people that will stand those syndrome. They. Virtually all of them have hypermobility. So people with hypermobility mobile joints can have clunking noises they can feel. The joint goes out of alignment, they can have breathing problems, they can have low back pain, neck pain, they can have thumb pain, shoulder pain. I mean, there's so many things that can go on. You don't have to have a connective tissue disorder to have this. You could even just have had an injury that didn't heal well. And then you could end up with a hyper mobile joint. And guess what that risks us for? Osteoarthritis.
Amber Warren, PA-C: So more damage to the joints.
Dr. David Musnick, MD: Yeah, because it's shearing too much. So that's it's a risk for that. But also one of the things that most people don't learn when they go to massage therapists. The most common reason why muscles stay in tight patterns or trigger points is the joint pain. The joint near it is hyper mobile. So then the muscles hold on really tight to guard the area. And you could do massages, but the thing keeps those muscles keep going back to.
Amber Warren, PA-C: Do you think our physical therapist colleagues are good at picking up on this?
Dr. David Musnick, MD: I've been trying to give lectures. I, I did it in the Seattle area when I was there and now I'm doing it in the Treasure Valley and the whole Boise Eagle Meridian area to just educate people about this. And I find the physical therapist didn't know much about this actually. Or they, they they're really interested though.
Amber Warren, PA-C: Yeah we've got some great pets in our in our valley. Yeah. How common is this issue?
Dr. David Musnick, MD: Well, Hypermobility you know, it's interesting, depending on. This is another interesting thing, a physical therapist, depending on the training, if they're manually trained, they are going to know about hypermobility, but only certain parts can really do the stress testing of the joints. Right. It's common. You know, a lot of people with thumb pain, they're hyper mobile and the CMC joint of the thumb, it's moving too.
Amber Warren, PA-C: Much arthritis in that joint. It might also be hypermobility.
Dr. David Musnick, MD: Yeah, or it might not be arthritis, but it might, you know, hyper mobile joints usually hurt. Say the person with a car accident, if it was significant enough, they might have a hyper mobile facet joint and then, you know, or someone that says, I've got to go to the chiropractor frequently, well, you know, I'm for good chiropractic, but not having to go frequently and continuously.
Amber Warren, PA-C: There's something bigger going on.
Dr. David Musnick, MD: Yeah, there's yeah. We have to be able to assess for hyper mobile joints. And so there's people with headaches that have hyper mobile joints in the neck. I've seen people that have rib hyper mobile joints that have back pain that nobody's been able to figure out sacral iliac. And the low back gets hyper mobile and leads to problems with weakness in the legs and the glutes and the thighs, and then can lead to the a buckling when people walk very common. It needs to be thought of more because there's ways to fix it. So very common. Like I said, some people have these connective tissue disorders like early stage and those those people all have hyper mobile joints. But there's also Marfan syndrome where people have really long arms and may maybe aortic valve problems. They have some hyper mobile joints, ligament looseness, but a lot of other people, they just have one or two joints that are hyper mobile. They don't have the whole you know, they don't have a connective tissue problem. They just they they have had injuries. And if an injury doesn't heal fully, it could leave us with a hyper mobile joint.
Amber Warren, PA-C: So I assume your evaluation of this is physical exam. Physical exam. Physical exam.
Dr. David Musnick, MD: Yeah. It's also history, of course. It's like, does this joint pop? Does it go out of alignment? Do you know it goes out of alignment? Like for the sake of iliac joint, it is one of the most common causes of chronic back pain that have been missed. Because if everybody's looking for a disc, it's not a disc. It's below that.
Amber Warren, PA-C: So a Hypermobility C joint is one of the most common causes of low back pain of Ms..
Dr. David Musnick, MD: Low back pain with chronic low back pain or surgeries that went on and disks that didn't work because there was this thing going on down below. So yeah, so that's it's very common. It leads to pain on almost like the triangle, the lines of the sacral anywhere along that people that persistent neck pain often have a hyper mobile joint, you know, people that pop their shoulders in and out. That's hyper mobile shoulder joints. This can happen anywhere in the body.
Amber Warren, PA-C: How do you treat it?
Dr. David Musnick, MD: And people with loose ligaments can have flattened arches in their feet, and that's hyper mobile.
Amber Warren, PA-C: Just because that plantar fascia is well.
Dr. David Musnick, MD: The plantar fascia may get loose, more like the spring ligament. And on the on the arch, the ligaments that hold up the arch can be loose.
Amber Warren, PA-C: Oh, so interesting.
Dr. David Musnick, MD: Yeah.
Amber Warren, PA-C: So what's your treatment?
Dr. David Musnick, MD: Well, first of all, to tell people to do certain things, like if you have hypermobility in your back, you better sleep with a pillow between your knees. I mean, I don't want people. You get that better of a pillow that support your neck, whatever it is you want your shoulder to be in neutral while you're sleeping. Then it's I give people a lot of precautions. The other thing is people have hypermobility in their feet, their knee or their back. I want them in stable shoes. So I really want everybody in, you know, good shoes that are appropriate for them. And then pro therapy is a injection technique in which the ligaments are injected, the joint capsule injected, and then people build more collagen and fibroblasts that actually build and stabilize the joint. What a lot of people don't realize is PRP is a type of pro therapy because pro therapy was the original treatment. And then, well, PRP is basically taking people's blood and processing it and putting the platelet rich factors in to produce a similar thing that happens with pro therapy. So both of those things can be done. I think pro therapy is preferable most of the time. Prp is pretty good for filling in a tendon, but pro therapy can actually use for chronic tendinitis, which is called tendon apathy. So that's usually the treatment.
Amber Warren, PA-C: Okay. How long have you been doing pro therapy?
Dr. David Musnick, MD: Long time.
Amber Warren, PA-C: And how else are 26 years? That's amazing. And how else are you utilizing therapy for more than just hyper mobile joints for tendons?
Dr. David Musnick, MD: So if someone comes in and they said, I've had a pain in the center and for a long time, for most of them, I'm going to want to get an ultrasound, a musculoskeletal ultrasound of that tendon. And if it's degenerative or it has what's called tendon apathy, then doing regenerative injections there can regenerate those tendons. Or if they have small partial tissue, something, it's very good for tendons too.
Amber Warren, PA-C: What else are we doing for degenerative tendons?
Dr. David Musnick, MD: Frequency specific micro figured and laser and laser. Yeah. Yeah. I especially use that for Achilles. The Achilles. Yeah, it's very good.
Amber Warren, PA-C: And that's combining nagging issue that chronic insertion, Achilles tendonitis. That's a big deal. Um, do the same injection procedures work for tendon tears or chronic tendinitis or using the same?
Dr. David Musnick, MD: Yeah. I mean, I use pro flow therapy and I've definitely treated with PRP as well. It just depends on the case. I think most people tolerate pro therapy with dextrose and then maybe some other things that I use my injections, they tolerate it, but PRP can be quite uncomfortable, right? Quite painful.
Amber Warren, PA-C: Right. So how does someone know if they have a true tendon empathy if they don't have this musculoskeletal ultrasound? Are there ways symptomatically that we.
Dr. David Musnick, MD: Can the tendon hurts at the bony junction where it attaches and. Like if they have a shoulder tendon apathy, when they lower their shoulder, it's going to hurt. When they're sleeping in bed, it hurts. It's gone on usually for more than two months. This is not like a tendonitis. This is called tendon apathy and it's very common. But the problem is if if someone who's looking at this does not realize what it is, they're not going to treat it correctly.
Amber Warren, PA-C: Does an MRI pick it up?
Dr. David Musnick, MD: Yes. But the nice thing is the musculoskeletal ultrasound picks it up and is less expensive and less invasive and doesn't spin your chin. So it's it's it's my preferred way to diagnose it.
Amber Warren, PA-C: So much more benign. Right.
Dr. David Musnick, MD: I think it's probably good to really diagnose tendon apathy as opposed to just assuming it's going on. I mean, I'll treat some people that don't want to get an ultrasound. Yeah, but I don't want to do injections unless we have ultrasound to say yes. It's definitely tendon apathy. Right. But if anybody's interested, I wrote a chapter in a book on tendon apathy.
Amber Warren, PA-C: And what's that book called?
Dr. David Musnick, MD: It's called Metabolic Therapies in Orthopedics.
Amber Warren, PA-C: Love it. Oh, so cool.
Dr. David Musnick, MD: Shows, ultrasounds and all the definition of tendinitis or tendon apathy and the treatments and all that.
Amber Warren, PA-C: So when we're talking about pro therapy for tendon apathy or loose joints or even back to talking about scar injections, why is this kind of idea of a head to toe evaluation, like a functional assessment necessary when you're when you know, when it might just be an isolated issue, like just a knee problem?
Dr. David Musnick, MD: Well, I mean, one of the things that some a clinician has to do is figure out in anybody what is causing their symptoms, not just labeling the thing. You got a tendinitis or are you going to this? I mean, I try to stay away from you. Got this. You need that. So one of my things that I'm always talking about is when I teach is figure out all the tissues involved, all the factors involved. What is the status of the tissues? Degenerative, torn loose, what's going on with the pain processing system. So when you look at all that stuff and then you have a knee problem, okay, what's going on with your feet? What's going on with your hips? What's going on with the nervous system that regulates the area? Otherwise you have incomplete treatment, you know, And well, I like to do really complete treatment and really look at all the issues that that are involved. And many times the knee is the innocent bystander. Right. And what if someone has weak muscles around the hip? What if that's related to a scar? You get that corrected and the knee tracks better. Yeah, well, if you just start treating the knee, you might not get anywhere.
Amber Warren, PA-C: Right. So something I've been training in lately to be able to utilize in my practice is peptide therapy, these peptide molecules and we talked about it previous interviews with both Dr. Hull-house and Josiah. How are you utilizing peptide therapy in your practice, especially in your treatment of musculoskeletal disorders? Okay. I had to go there. I'm sorry.
Dr. David Musnick, MD: Oh, goodness. Well, I mean, there are times when I think it could be useful to add some peptides to the therapy. There can be. I do that on a very individual basis. Bpc 157 can be helpful. There's another one called TB 500. They can be very helpful. I mean, if people take BBC 157 internally, it's more helping the got right. If you injected it near the area, it will help the musculoskeletal system or um. So. Those are the main ones that I think you know, that I think about with, you know, sort of regenerative medicine.
Amber Warren, PA-C: No, I love it. It's just a hot topic right now, and we've touched on it a little bit. So I was just curious how you're really utilizing it.
Dr. David Musnick, MD: Yeah.
Amber Warren, PA-C: Anything else that we can touch on? Pro therapy. Scar treatment. Scar injections. That we didn't cover.
Dr. David Musnick, MD: Well, I just think it's important for people to be evaluated. You know, it's like you don't want to guess. Do you have one? Do you have an issue like this? Like if you got persistent, if a person has persistent muscle spasms, persistent neck pain, back pain, persistent joint pain, they should be evaluated for this. And. Physical therapists may be able to evaluate them. Someone who. Someone has to be able to test for this. I mean, when I see a patient, I test every joint I'm looking at for, you know, Is it loose? Isn't it? There are imaging studies. You know, there's imaging studies that can be done to the neck. Believe it or not, some of the ligaments of the neck need to be tested with special views of the neck x rays of the neck like flexion extension and even open mouth, because the open mouth is the only one that shows the upper cervical area. If someone's wondering about scars, they should be checked out for it. It's like, you know, just being checked out for these things as part of someone's issue or maybe all of someone's issue is just important because sometimes, you know, it's like people tell me. Wow, why didn't anybody else check for this or look for this? It's often an underlying issue like the hypermobility or the scars they should just be checked for.
Amber Warren, PA-C: Yeah, no. So important and not not not well known enough out there in our community.
Dr. David Musnick, MD: That's right.
Amber Warren, PA-C: Well, thank you, Dr. Musnick. You know that I end my interviews with. A piece of advice that you offer your patient population that has moved the needle the most for them. What would that be?
Dr. David Musnick, MD: Well, I don't want to say the same thing. I said podcast.
Amber Warren, PA-C: That's really what it is.
Dr. David Musnick, MD: Now I'm going to talk about something different. We could do a whole podcast on this sometime in. Having a good attitude. Mhm. So I find I like to ask my patients is there any part of you that doesn't want to get better. Is there any part of you that feels so hopeless or is there any part of you that feels like this won't work? And then countering it with what would you say to your best friend? You know, what would you have your best friend say? Yeah, even like saying three times a day I can get better or there's reason for help. Hope in my case, like it's like an exercise in attitude exercise that I think can help people. So, you know, for any of our listeners, think about some kind of attitude that you want to instill. And just like anything, you've got to practice it, you know? And it's a habit, like have a habit of having a good attitude.
Amber Warren, PA-C: Glass half.
Dr. David Musnick, MD: Full, right? And regarding your health design, a phrase that you can say that will encourage better healing, better health, improved health, say it three times a day until you believe it.
Amber Warren, PA-C: I mean, there's good data on that, right? Oh, self-fulfilling prophecy, that that belief mentality that you can heal. Oh, yeah. Amazing data on that. Yeah.
Dr. David Musnick, MD: No, it it really helps.
Amber Warren, PA-C: That's awesome. Thank you. Dr. Musnick, thanks so much for being here.
Dr. David Musnick, MD: You're welcome. Thank you.
Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundations podcast. For more information on topics covered today, programs offered at FMF and the highest quality of supplements and more. Go to Fun Med Foundations.