How to Fix Chronic Pain with Dr. Sneha Gazi

Would you like to increase your quality of life and reduce pain? Are you prepping for an upcoming surgery or struggling with pelvic health? Make sure you know the right ways to go about it in this next episode.

04:34 - Common conditions that need physical therapy
05:00 - Pelvic health in perinatal space. You need to improve pelvic floor even if you've had a c section
08:55 - What is pelvic floor?
13:55 - Prepping for surgery with physical therapy
18:55 - Difference between PT and chiropractor and personal trainers.
23:29 - Fixing the Why
24:00 - How to help dancers and athletes get back to play

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Transcript

Dr. Carrie Lam, MD: 0:06

Hi, welcome to the Dr. Lam show. I'm Dr. Carrie Lam. Today I have Dr. Sneha Gazi here with me. She's a physical therapist based in New York. She also does telehealth PT in New York, New Jersey and Maryland. She deals a lot with decreasing body pain and helping people's quality of life. As she was a professional dancer and certified yoga teacher, her passion for movement led her to the work that she currently does. We are very glad to have her here today on our show, as we're going to talk about not only seeing what would be the best advice if you have to go to surgery to not do that as the first choice. But also if you are interested in pelvic health and women's health, she can also teach us a little about that in chronic pain. So welcome, Dr. Sneha.

Dr Sneha Gazi: 1:02

Thank you so much, Dr. Lam. It's a pleasure to be here.

Dr. Carrie Lam, MD: 1:05

I see that you have a strong passion for helping people with chronic pain. Tell us how you came to incorporate this holistic background, Eastern and Western into your practice.

Unknown: 1:17

Sure. I am from the Indian culture. We have a lot of eastern practices of healing, we do a lot of herbal medicines, and there's a lot of stuff out there in our culture for naturopathic healing and natural healing. There's Ayurvedic treatments and tons of things that are outside of the western evidence based and researched approaches. So growing up, I always was exposed to that. But of course, I am a doctor in physical therapy. I went through seven years of school and dissected cadavers and completely understand and trust and work in the scope of Western medicine as a doctor in physical therapy. So in my practice, I combine a lot of those elements to help my patients and meet them where they're at, because people's understanding of healing and wellness is very different. And there's not always one path to recovery. There are many ways to incorporate holistic approaches. For example, I recommend acupuncture to a lot of my patients, or I will send them off to other providers who I think could complement our services. I have my own podcast, and I talk about this and bring on guests who are, around the space of health and wellness as well. So I really believe that different professions can provide so much more insight. By working together, I think that we can serve our patients better, in lots of ways. So yeah, that's kind of my background. I'm also a certified yoga teacher, and an Indian classical dancer. So a lot of my, training and understanding of movement comes through that as well outside of my DPT. So I can't really separate my dancer self and my yoga self and my doctor self. It's really hard to do that. It's really everything that I offer to my patients, comes from all of those backgrounds and understanding all of those disciplines.

Dr. Carrie Lam, MD: 3:15

That's true. And that's what I love about integrative medicine. Integrative means not only Eastern and Western, but it's the tools that you can bring together from different specialties. I definitely send my patients to physical therapy all the time, especially if they have musculoskeletal concerns, or pelvic floor issues, those PTS a great segue in helping patients structurally, with exercises and things like that. So

Dr Sneha Gazi: 3:43

Again, so many of what we say is like Eastern medicine has been evidence based now in western medicine, too, right? Glasha techniques, acupuncture, cupping, we see that now in the western medicine, as you know, medical acupuncture, and, you know, IASTM are instrumental assisted soft tissue manipulations. A lot of these things are already out there, people are just understanding. Just because there's maybe not RCTs and systematic reviews, like others so much, people have been using a lot of techniques for centuries. So at the end of the day, it's really the technique and then how does that apply to the patient, does the patient trust that technique, and understand that how it can be beneficial. And so that's where I think communicating with the patient is more important than kind of categorizing it as Eastern or Western.

Dr. Carrie Lam, MD: 4:31

I love that definition. So what are some very common things that you see and some advice you would like to give in general?

Dr Sneha Gazi: 4:42

I specialize in pelvic health and treat across the age spectrum. So I treat one month old with torticollis and developmental delay, and I treat 92 year olds with gait and balance, dysfunction and really everything that you can say that's orthopedic related in between, but my specialty focus is pelvic health. I have a lot of patients within the perinatal space, pregnancy to postpartum. So I treat many birthing individuals as well. So within that scope, there's a lot of unique diagnoses or common themes that I tend to see in the perinatal space, which is very underdiagnosed and under spoken and are taboo topics. I love talking about those with people, because everybody knows about frozen shoulders and ankle sprains, which is like back pain and neck pain, and we know what that is. And when we feel it, we go get help. But a lot of times people don't get help for things that are related to the urinary system, reproductive system or their GI tract. So when it comes to pelvic health, we talk a lot about bowel, bladder and sexual dysfunction. My focus in that is really my passion and to help people understand, when you have good quality of life, it's really when all systems in your body are in check. And especially in this world, which has been always a very male dominated medical system for a very long time. And so when women entered the system, I still feel that female physicians, surgeons, OB GYN don't fully understand the spectrum of what their patients are undergoing, particularly for people of color. A lot of the statistics out there on maternal mortality for, black and brown mothers in this country, shows that a lot of the work needs to focus on, the care that we provide as professionals, and looking at these birthing individuals. And then also, even more in a focus lens on women in particular, who are not getting the treatments that they need, because it's kind of brushed off, like, you'll be fine. They don't really treat C sections as major abdominal surgery. I mean, you get an ACL tear, and you have prescribed, months of physical therapy. In a C section it cuts through layers of tissue and organs and fat and muscle layers in the most central part of your body. And then you're expected to return to work and return to function and carry your baby and feed your baby and also do the chores. So I think that those are the themes that I talk about in my work and my practice, which maybe people don't know too much about, or maybe or just kind of understanding the spectrum.

Dr. Carrie Lam, MD: 7:34

We definitely need to talk about it more, because we're not heard. And to be able to encourage women to take maternity leave and get paid for it. We have to voice our concerns. America, is one of the few countries that doesn't even pay for maternity leave. So sad. Right? And, it's interesting that you brought up C section cutting through. What are some common symptoms that someone would need to think about to make them go get pelvic floor PT, and think about pelvic health. What are some of those symptoms?

Dr Sneha Gazi: 8:15

So it runs the gamut. But I would say for a C section in particular, I think the biggest myth is Oh, I got a C section, my pelvic floor is fine because I did not have a vaginal delivery. So everything should be okay. Well, that's not always the case, because it's really the 10 months that the birthing parent is carrying their child, the postural shifts to orthopedic shifts that we know happen. That's physics related, also very mechanical shifts that happen to the spine and to the body. The muscular changes that happen from changing the position with your center of mass being put more forward over your base of support. So all of those things, change your pelvic floor. And for those of you guys who are listening, who don't know what pelvic floor is, it's a set of soft tissue structures located in your perineum, that is between the pubic bone and tailbone. You can think about everything that you sit on, if you were to ride a bike, or a horse, on a saddle, it's the same area. It's consisting of muscles, there are ligaments, glands, nerves, or blood vessels, fascia, and connective tissue. You have all these in your shoulder joint, knee joint or your ankle joint. It's the same kind of structures, it's just acts differently. So if you have, for example, somebody who has a limp from their ankle sprain, and if they're wearing crutches, or if they're on a boot, a lot of times they'll experience lower back pain. And why is that? Because they're off balance, right? Their gait changes. And so we take a look at that from a holistic perspective. With a C section, you're not foolproof to have a lot of pelvic floor dysfunction. During pregnancy there are those shifts in your body that can shift the way that your muscles are structured and can also just generally change your body. So when we specifically say C section though, what I find in my practice the most is lower abdominal dysfunction, discomfort, and lack of ability to access and engage their deep core muscles in their front of their abdomen. So a lot of people will complain of pain and soreness and tightness at the scar site. That's because when there's a scar, there's a natural healing process. When there's a process, there can be scar tissue adhesions, which are basically restrictions and the connective tissue, which might be natural, but can be disruptive to movement and function. So one of the things we really need to focus on in that area, is mobility. So that can be done through direct scar tissue manipulation, visceral mobilization, mobilization around the organs, and or general full body structures that are specific and catered to what that person's problem is. These can't be blanket exercises, because I can find two people who had the same kind of birth story, but their bodies can look totally different. And so I wouldn't just tell everyone to do the same stretch and hold it for 30 seconds. That's why it's important to do a full musculoskeletal orthopedic exam, and in that initial evaluation, understand how their spine is moving, how their pelvic girdle is functioning, how is their sacroiliac joint, how is their coccyx functioning, and then assess the muscles of the pelvic floor and the deep abdominal muscles. And from that information, we can tailor specific exercises and stretches to both build mobility and the stability needed in those deep pelvic floor muscles. So people can feel like they can tolerate all of these new activities, which literally happen overnight, you have no baby, one day and then you have a baby in your arms. All of a sudden you have to feed, put to sleep, pick up on and off the floor. You have like a million things that I call the baby related tasks overnight. And so in order to be able to sustain that, and then potentially have to go back to an employer who's telling you, you have no maternity leave, there's like a lot of societal components to this. I think that addresses the quality of life problem here. The key to helping people get back to function. Also there's the urinary dysfunction, so urgency, frequency, urinary incontinence, and then constipation, tailbone pain or hemorrhoids, or episiotomy, you know, kind of related things that can also happen as well.

Dr. Carrie Lam, MD: 12:33

That's good. I like the mobility, stability and, building up the core and also stretching and making sure that it's nice and soft. So it's important to find someone who can do this evaluation, if you have any of these issues, whether it's a C section, or even normal birth. So we talked about C section, but normal birth, you also go through that 10 month pregnancy and changes, right. So your pelvic floor muscles also change. I know because I recently gave birth. So I was really trying to really concentrate on my own pelvic floor. I did a lot of squats when I was pregnant, to really build up that floor. Even if you're pregnant, you can prepare the for the birthright when you build it up while pregnant, because I think it actually helps me give birth much easier. Maybe she came out in like five to six pushes. It was really a good first time birth. So thinking and being cognizant of that pelvic floor is important all throughout a woman's life. So what do you think people should do, if their doctor says, you need to go get surgery. But they can always optimize first, by going to physical therapy and even before and after? What are some of those steps that you would recommend?

Dr Sneha Gazi: 14:12

We're kind of stepping away from just the pregnancy realm here. In general orthopedics, I definitely think that if you have an injury, and the doctor immediately says that you need to get a surgery, please go the other direction. Because most of the time when it comes to orthopedic related chronic pain, not a car accident or a burst appendix. But if in general the neck hurts, knee hurts, my back hurts and they scan you and say you're broken and you need surgery, then leave. There are so many things that you can do conservatively to help you. Firstly, we got to figure out why that thing happened in the first place, especially if it's not an acute injury. I'm talking about for things that have built up over time, and are more like on a chronic basis. It's not from an accident or an incident or a fall. But if there's some pain that's been lingering, that's been getting worse and worse for you, and you go to the doctor, you need to figure out why that's happening. Most of the time, it's because of the way we're holding ourselves in space and the way that we're moving. We have to figure out what those root causes are, which is hard work. And that's what a physical therapist is going to do is change those behavioral patterns, strengthen the muscles that need to get stronger, relax, and lengthen the muscles that need to get longer and more flexible, and get you into long term health, that's more sustainable. Surgeries are often a one time thing and you're going to have to go to PT after anyways. For any major surgery, they're going to tell you, you have to go to physical therapy. So might as well go to physical therapy at first, and find someone who's experienced and good. Find somebody who's vetted in that particular area of the body, and understand also how to treat you holistically within that system, and then go and do your therapy and do your homework. Anything that's done to you is not long lasting. Anything that you do is more long lasting, manual therapy, adjustments, mobilizations, massage, anything that's like cupping, injections, lotion, ultrasound, or electrodes, etc are not going to be long lasting healing factors. The long lasting healing factor is how you move your body. That is going to only change with awareness, number one, and what you're doing and actually be willing to change. I can tell you the number of times that I have a patient, I'm an in-home physical therapist, so I see people in their environments all the time. And the number of times I will see somebody and be like, let me see how your desk setup is. And they say, I sit on my bed and I say we got to change this. And then three weeks goes by and nothing has changed. And I've told them exactly what they need to do. It's compliant. If you're not willing to change the way that you hold your body in space, we're at a loss. So in physical therapy, we do manipulations, we do mobilizations, we do massage, in a lot of states, we do dry needling, which is basically acupuncture, but in a completely different sense, not on meridians, or not through Chinese medicine, but through motor neuron, alpha motor neurons and understanding muscle spasms. But everything we do the exercise therapy, we do the education, we do the pain neuroscience, we do it all. And so getting a good physical therapist who really understands the entire musculoskeletal system, understands your needs, and your goals, is key. Surgery, injections, all those things have a time in place. There are tons of people that I send to surgery or is into injections. I'm not saying that those are terrible things, they're definitely have a time and place. They are life saving in so many cases. But I'm talking about a very specific case of the orthopedic pain that somebody feels and they go to the doctor without doing any conservative treatment. And they're prescribed surgery. This is a problem with America's medical industry and insurance, but that's another topic.

Dr. Carrie Lam, MD: 18:38

That's so true. So definitely red flags when your doctor says you need surgery, but you haven't gone through PT. That's always the first step, before surgery. I would say unless it's yes, like you said the appendix or similar. So I love that whole person kind of rundown that PTs go through how are you different from the personal trainers, chiropractors, just so people can understand what PTs do.

Dr Sneha Gazi: 19:09

Physical therapists go through typically, different course of training. Most people like me go through four years of undergraduate degree with pre med. There's only a few classes that are different for pre PT and pre med. And then you do three years of a doctorate in physical therapy. So this includes cadaver dissection, and tons of courses that are medically oriented. You have lab work, you do rotations and the training. Once you graduate is that you have a DPT or a doctorate in physical therapy. In many states, we also have direct access. I think most or all states at this point, you have some level of direct access, which means you don't have to go see a physician or a doctor in order to get a script for physical therapy. You can go straight to a physical therapist for an initial evaluation and they can screen you for red flags or screen you to do a full systems review and say, if you a candidate for physical therapy or not? If you're not, they will refer you to the correct provider. For example, I had a patient three months ago, with a nerve pain at the top of her foot. I did my full evaluation of her lower spine and everything that I needed to do to understand what's going on. I suspected that this is not a spine related issue, or sciatica. This looks like it's a Morton's neuroma. And so I sent her to go get an ultrasound, and lo and behold, that's what it was. It's basically a nerve bundle at the top of the foot in between the toes, and so we understand what it is. So physical therapists have full training to identify red flags, like deep vein thrombosis, or cardiac issues etc. We understand the person who's coming through the door, and then we screen them, and evaluate them as a holistic person. We do a full body evaluation, whether you're coming into me for neck pain, ankle pain, I'm taking a look at your posture, your overall general mobility, your general strength, and then I'm assessing all of the pieces that I need to to understand and devise a plan of care. And because we're medical providers, we work with documentation, we write SOAP Notes, you know, the subjective, the objective, the plan, the assessment and the plan. And we create medical documentation, we put you through a plan of care based on all of our tools, to help you with treatment. We communicate with our patients, and then that can involve manual therapy, exercise therapy, neuromuscular, functional assessment, and other modalities. So having said that, personal trainers work just with the exercise component of this. Unless they have other certifications, personal trainers are not licensed to put their hands on you and stretch your body. They're not licensed to use your body and move your body. They're allowed to instruct you on how to do exercises. And of course, there's different certifications and different levels. But physical therapists are doing an assessment and doing treatment and a plan of care for either prevention or rehabilitation. If that person is going through injuries, or in going through pain, the personal trainer should refer to physical therapy for rehabilitation. And then if you take a look at, for example, massage therapist, they are not prescribing exercises, they are not doing medical documentation in the same capacity. Their role is just with the manual massage. And sure tons of people can go and say you know, I have an ache or pain here. Physical Therapists are not going to look at why it's hurting you. We're doing an investigation to figure out and create long lasting health and not just doing things to you and understanding everything when we go back to whatever you do yourself is more long lasting. So we do we focus on the functional and the postural training and the modify their activities. So you don't feel those pains to have to get weekly massages. I like weekly massages but that's not the point. Our plan is when you walk in, we're making a discharge plan for you. You're not in physical therapy forever. As soon as the patient walks in and figuring out in how many sessions can I get them better, you know, in the least amount of time and maximize the value out of it.

Dr. Carrie Lam, MD: 23:28

I like trying to get to the root cause, because that's what functional medicine is. To get to the root cause and then giving you the tools, so that you can go home, do those exercises, rather than, having a massage every week. That's just great to know what is structurally the problem and then fix that. So using the why. You said you're a dancer and a probably a lot of athletes are dancers. How do you do a movement screen when you're evaluating your patients?

Dr Sneha Gazi: 24:09

Great question. I'd say that with dancers and athletes, they're very similar in the sense that they need to get back to stage, get back to the court, get back to sport, get back to play, that's their goal, right? Their body is their livelihood. And usually there's a lot of, urgency to get better quickly, especially the pressure from parents, coaches, trainers and directors. So when I'm doing the screening, it's very similar to how I would do everybody else's, but I'm really targeting on healing time and making sure that I'm maximizing recovery in the shortest time that I can safely for the patient and making sure that everybody is on board with that plan. So the assessment, the treatment, the diagnosis, all of that really is the same. There are some specific, objective measures or tools, But the main goal is to get out of bed pain free. I look into the steps needed to make sure that these motions don't hurt you. It's the same way with a dancer or an athlete. If I know that a dancer says during these particular movements is where my pain gets exacerbated, I look at ways that we can either modify that or we can rehabilitate that with specific exercises and rehabilitation techniques to make sure that that's as pain free as possible. Same with an athlete, for example, I had a soccer player once who told me, it's just with the tackle that injured his ankle and exacerbated his pain. Once I know what structures are involved, and why it hurts, I target those very specifically and make sure we're maximizing it so that if and when he gets into a position, it's a lot of reactive stuff, athletics and a lot of proactive stuff and performing arts because it's planned ahead of time. So I based on what I see a lot of athletes, I do a lot of plyometrics, and reactive balance. With dancers, we're really focusing on how do we create stability through a movement and make sure that when they're doing that movement or not going off balance, or, if their joints are moving in a particular way that they feel more stabilized and supported.

Dr. Carrie Lam, MD: 26:28

Dr Sneha, it's been great having you on our show, as we talked about pelvic floor, PT, and also how to get a second opinion if you needed to really get PT, before surgery or after surgery. And we are thankful that you came here and so any last words, or where can people find you if they wanted to see where you're at?

Dr Sneha Gazi: 26:54

You can see me on my website, www.snehaphysicaltherapy.com. That's my handle on social media as well, Facebook, is snehaphysicaltherapy and my handle on Instagram is at snehaphysicaltherapy as well. I hang out with all the people, share videos and tips and advice. I also have a podcast called Fit as a fiddle. We share similar topics on health and wellness. So Dr. Lam, maybe you should come on my show as well.

Dr. Carrie Lam, MD: 27:29

Awesome. So thank you for being on our show if you liked and if you really learned a lot, definitely share it and subscribe to our channel, and we'll see you next week.

Unknown: 27:47

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