In mid-December, I lurched into the Physio Logic Integrative Medical, Wellness, & Movement Center offices on Fulton Street as part a depressingly common statistic. Promptly upon entering middle age, I’d been confronted by two of its seemingly inexorable shadows: knee and back pain. There was an ill-conceived and extended heavy furniture moving adventure in the fall that kicked both into high gear, but the knee pain instability and stiffness and discomfort in my lumbar region I’d not only taken notice of for some time beforehand, but also vaguely suspected the real cause of: a life lived at a desk and with a paucity of exercise. Maddeningly, both seemed to be improved in the immediate but worsened over time by brisk walking or other attempts at redemptive activity, and were subtracting about 20% of the joy in doing virtually anything…including sleeping, working, and being a help to others. Life was, as a result, getting smaller, both geographically and spiritually, and I was out of solutions.
I was also, according to The Global Burden of Disease Study of 2010 (the most comprehensive worldwide observational epidemiological study to date) almost dully representative of a trend. Among its findings was that low back pain is not only on the incidence-increase worldwide, but also the single leading cause of disability, and causes more life-years lost to dis-ability than any other condition. And, according to a 2016 Joint Pain Epidemiology summary report from the International Association for the Study of Pain, “…approximately 30% of adults report some form of joint pain within the prior 30 days, with the knee joint being the most common site.”
Other than encouraging me not to lament my depleted condition unduly, Dr. Stephen Szaro, Doctor of Chiropractic at Physio Logic—an integrated practice that combines his field as well as general medicine, physical therapy, massage therapy, acupuncture, and its own branded FRESH Integrative Health program that emphasizes nutrition—began to investigate.
“In a knee situation like yours, I’d first check for any ligament instability…any meniscus tears or a patellar tracking disorder due to torsion of your tibia or torsion of your femur,” Szaro explained. “There are many different approaches to take from an orthopedic perspective, but those would be a start.”
In practice since 2009, Szaro trained in a sports chiropractic office with his mentor, Gregory Doerr, DC, co-founder of the Functional and Kinetic Treatment with Rehab (FAKTR) chiropractic concept and named The Association of New Jersey Chiropractors’ 2009 NJ Sports Chiropractor of the Year.
“[Doerr] has done amazing things with the knee and shoulder, to name a few examples—areas you wouldn’t expect a chiropractor to be treating,” Szaro said. “FAKTR is essentially a soft tissue technique that centers around pain provocation: how to provoke pain in order to treat it better. Say you’re telling me that you’re having trouble walking upstairs or downstairs, or feel pain in a squat or when you run. I’d then try to place you in different positions that will provoke the discomfort, so we can isolate what tissue is involved. If we can do that, either myself or a massage therapist, or both, can do a massage technique in that position of provocation that is quick and effective. You’ll see almost instantaneous results.”
FAKTR applications, as well as Active Release Techniques (ART) and taping techniques like Kinesio tape and Specific Proprioceptive Response Taping, might strike the uninitiated as outside the realm of traditional chiropractic, but they reflect the paradigm-dynamism of the practice, founded in 2002 by Dr. Rudy Gehrman, DC, Physio Logic’s Clinical Director, and Lynda Salerno Gehrman, its Pilates Studio Director. The formative idea was not only to house a variety of therapeutic and movement-based techniques steps away from each other—saving patient time and effort—but also to argue against what Szaro described as the “five-minute visit” syndrome.
“A growing problem in medicine is the segregation of effort…being shuffled to a specialist after a few minutes with your primary care doctor to, say, an orthopedist for your knee,” he said. “But will they form a team? Are they sharing all the critical information? I believe that you can’t fully treat somebody just from the outside in. I can treat all the soft tissues and will rehab your knee as best I can, but if I find there are more problems going on—an inflammatory problem from a poor diet, say—there are ways, naturally and nutritionally, to help reduce systemic inflammation, which is going to help your knee heal.”
This “functional medicine” approach can include a variety of tests not likely conducted in typical orthopedic settings. Blood work, digestive analysis, hair analysis, and allergy testing can all help determine primary or contributing causes of inflammation throughout the body, of which the knee or back might just be the most vocal presentation.
“The point is to bring more of a homeostasis to the body, which goes a long way towards recovery,” said Szaro.
The team approach at the practice—in which M.D.s, nutritional experts, sports medicine specialists, and massage therapists discuss each case—was illustrated by same-day postchiropractic consultations with Rehab Technician Diane Lee, and Amy Montia, a Licensed Massage Therapist and certified Active Release Technique practitioner, with advanced training in Myofascial Release.
“It sounds glib, but massage is really a science and an art,” said Montia, who was formerly a molecular pathology researcher in cancer genetics. “And its benefits are physical and psychological. Some patients might come into the practice for massage therapy alone, others will get massage in tandem with physical therapy.”
Montia mentioned an important distinction, too, between licensed and non-licensed practitioners.
“There are many ‘bodyworkers’ out there, and those who advertise themselves as such may or may not be New York State licensed,” she said. “This doesn’t mean they’re not good at what they do, but they might not be formally trained according to NYS standards.”
“If someone comes in because they are doing physical therapy,” Montia explained, “and one of his or her issues might be restoring alignment or correcting imbalances, as I suspect in your case, Dr. Szaro might instruct us, for example, that someone’s IT Band [Iliotibial Band: a thick, flat, tendinous band that runs down the outside of the thigh from the hip to the shin] might be pulling all the way up into the iliac crest, and ask me to work along his lumbar fascia or use ART to make the physical therapist’s job a little bit easier.”
Addressing issues of fascia, a thin sheath of fibrous tissue enclosing muscles, organs, and other body components, is vital to the massage therapist’s work, Montia added.
“Fascia is almost like a mesh shirt that helps support movement and keeps us standing up straight, and you simply can’t address muscular issues or bone issues like arthritis or joint pain without addressing the fascia. What happens is, where you have an area where there’s arthritis or inflammation, the fascia is going to end up sticking around that area…it gets thick and creates adhesions, and that contributes to muscle tension and tightness. So, myofascial work is like ironing you out…literally.”
Though results can be perceived in a single session, typically, myofascial work plays out over a number of weeks, and is often combined with massage-associated pain management techniques like whole-body muscle relaxation and breathing exercises.
“And during the rehab and recovery process, we’ll also talk about what muscles and other tissues we’re treating so that we don’t under- or overwork areas,” Szaro added. “This is also a part of the functional medicine dynamic—the task of finding out to what extent your knee pain could be diet-, muscle-, balance-, or physical trauma-influenced—and how to get you better faster. Your condition may be common, but the solution to it needs to be detailed, and unique.”