Episode 106: Best Tips for Managing Joint Pain the Holistic Way with Dr. Jacob Swart

Hola amigos! Welcome back —–

Announcement: We have a team of HAES trained RD nutrition professionals and work with a team of psychologists within David’s private practice, Orozco Nutrition. If you are struggling in diet culture or want guidance with nutrition, please do not hesitate to reach out. We want to hear from you.

Summary: Have you or a loved one been to physical therapy and left disappointed?  Tune in to listen to a pioneer physical therapist who uses traditional training combined with other related fields that revolutionize how we recover from injury and pain. 

Highlights of this episode:

• Short-comings of traditional PT
• Related professions of PT
• Rehab vs. performance
• Holistic physical therapy
• How weight centric care damages us

Introducing Our Guest

Dr. Jacob Swart is the President of a performance based physical therapy company in Atlanta, GA called Athletes’ Potential. As a company, it is their mission to prove that if you have a body, you’re an athlete. They have helped thousands of people in the Atlanta area get back to living the healthy lifestyle they deserve and they are just getting started.

In addition to receiving his doctoral degree in Physical Therapy from Ohio University, Jacob is also, a certified strength and conditioning specialist and CrossFit Level 1 coach. Prior to physical therapy school, Jacob coached at an athletic performance enhancement facility where he helped develop specific training programs for various levels of field, court, and strength athletes as well as helping the general population reach their health and wellness goals. Since that time, Jacob has worked with the men and women of the United States Air Force, current and former NFL players, US Olympics, multiple collegiate sports, CEOs, and desk jockeys alike.

He is passionate about using his advanced background in strength and conditioning in conjunction with his training in manual therapy, performance dry needling and joint manipulations to help his clients reduce their risk of injury and perform at an optimal level. His goal is to help people get out of pain, optimize performance, and ultimately, become the best version of themselves.

FULL DESCRIPTION (not a transcript): 

[00:00] A long time ago, David was really focused on the Zone Diet and his Aikido training. In 2002, during a workout, his knee popped from a miscues tear. In hindsight, David believes he ignored what his injury did to him. He hopes that this guest will help others know they have options and how diet culture sabotages our health.

[5:30] Dr. Jacob Swart’s Background

Dr. Swart explains that a very high majority of orthopedic professionals, had an injury to lead them into this field. As a teenager, he had knee, wrist, and heart surgeries. At one point, he tore his quad. After going through physical therapy (PT) several times, after his last injury, he sought a different approach. A strength and conditioning coach who practiced holistic training helped young Jacob Swart heal. He realized that rehab and performance were not linked. He wants to bridge these gaps.

He did not ignore traditional training. He majored in exercise physiology and post-graduate earned a PhD in PT. In PT school, he continuously observed a gap or misunderstanding in PT school that was experienced during his clinical internship.  He explains that in traditional PT, volume of patients per day, is the focus. 1-3 people may be seen at one time by one PT. This does not work for the majority who are trying to improve their performance, reduce pain, and want to go back to pre-injury performance. Jacob says he knows what his expectations were, and he works with clients to achieve their expectations.

[11:50] What is the difference between a personal trainer, athletic trainer, PT, strength and conditioning coach?

Those lines are getting blurred more and more every day. Broadly speaking, a physical therapist will have a higher level of education, it requires a doctorate. An athletic trainer, will be on the front line of athletic performance. If an injury happens, a trainer may know the first line of defense, kind of an EMS of the sport world. Strength and conditioning coaches require a minimum of a bachelor’s degree, CPR/AED certification, and an standardized exam. A personal trainer has the least amount of regulation and training. You must be 18 years old and pass an exam. You have to hope you get a good one. But, there are bad PTs too. Personal trainers will likely focus more on aesthetics and general performance. Strength and conditioning specialist, will get athletes will get to the best he/she can be. PT is typically seen post injury in rehab. But they are called the “movement experts.” That is hard to agree with because many PTs cannot watch someone do a clean and jerk movement and critique it. Dr. Swart believes, you cannot go wrong getting strong (which is something traditional PT does not cover). David points out, this should not be an extreme, recalling his experience with athletes who push themselves so hard it becomes unhealthy.

 [17:00] What are the challenges of rehab to performance? 

In traditional PT land, you work on the 0 to 100 degrees of range of motion. Can you perform a higher degree of range of motion? Insurance companies won’t pay for performance. Once you can move your knee, the insurance companies stop paying. This is a problem when the individual wants to do more than get up and down the stairs. The fear of pain often stops individuals from doing activities that are associated with the injury. The PT is not solving the underlying problem in most clinics, it’s a box check-off list for insurance companies. 

David has the same problem in his nutrition practice as a RD. Insurance only pays for so many appointments, even when the client would highly benefit from more professional services. 

[20:10] What do you do differently in your clinic?    

Let’s say you come in with pain when you run, or walk…the provider has to watch you perform in order to spot the problem. We watch our clients when they move, they are not left to do the movement solo. They can do that at home.

The body is actually robust, it is not fragile. Focusing on the pain, or isolating a body part, isn’t doing much. Pain could have been building for years.

One of Dr. Swart’s clients came into his clinic in a wheelchair because of two torn Achilles’ tendons. She could take maybe 10 steps without pain setting in. This affected her life in a downward spiral, as depression, poor nutrition, and poor sleep occurred.

If he didn’t address those issues first, he wouldn’t have gotten anywhere. She made progress, but then she lost a loved one and went back to baseline before she could make progress again. This is the complexity of being a human being. The layers may contribute to pain. We have the ability in our clinic to take that time to learn about these layers. Providers in massive clinics do not have the time for this holistic care. Athlete’s Potential – name does not include PT for a reason. Dr. Swart has take his traditional training and developed a new way to work with clients. They do not “babysit” clients. Providers spent their time evaluating the client’s movement, checking for progress or declines, he wants to spend time wisely. 

[26:45] What do you get as a client at Athlete’s Potential? 

The client gets one-on-one sessions with a PT for 1 hour.  PT does an evaluation to get to really know the person’s life. Then, a more technical evaluation including a full screen of the body and functional level of movement. If we are not sure yet, we may go on a performance trial. We create a plan of expectations and estimate a timeline. You get a customized plan with many resources and portal secure messaging to communicate with your provider.

Sometimes, the client’s issues are really something fundamental or essential is missing, like breathing techniques for minor back pain.

Rarely do we see people more than once a week. In that rare occasion, usually we have to use a new technique, personalized blood flow restriction BFR training.  This requires specialized equipment in our clinic. BFR is personalized, but let’s say you have knee pain as a runner and the usual tools are not helping. The PT monitors your walk or run in real time, and data is gathered to assess how much blood flow needs to be restricted to your leg. Yes, restricted. This minimizes the built-up waste products of exercise. If you have ever felt a burning sensation while exercising, that is hydrogen ions. It’s not always lactic acid. Waste products are acidic and include hydrogen ions, lactic acid, carbon dioxide. The increase acidity in the system can disrupt the body’s balance of pH, or acid and base, chemistry. The body is very specific about the desired level of acid, or pH. Being able to change this, is a “biohack,” can expediate the healing process. This new tool is a huge paradigm shift when all others methods fail.

[35:45] What other approaches you do prefer to use?

We had a client with ankle surgery requiring a post-op hard cast. We had him cycle almost immediately after surgery and created a conditioning recovery plan. When the hard cast was removed for a soft cast, the doctor was shocked the patient did not have muscular atrophy, or a skeletal look. No centimeters were lost on the client’s circumference, which is rare. That’s a huge win.  David jokes that he could not image the itchiness from the sweat in a hard cast.

Dr. Swart says, with this immediate intervention, we don’t have to rebuild nearly as much; we gave him a nice platform. Even lighter load exercises will aid the metabolic response to exercise, not just the physical response to exercise. Dr. Swart explains how the natural human growth hormone (HDH) plays a role in PT and strength conditioning. Note, this is not using the supplement form of HDH, which is dangerous.

Dr. Swart’s metabolic approach acknowledges that when people are “stuck” and sitting in one place, the body’s natural waste products, like ammonia, builds up. The body, which is a smart machine, will direct blood flow to the working side to the working muscle and limp.

David and Dr. Swart caution – don’t try any of this without a professional’s guidance. For example, there was a group of body builders who wanted bigger calves for their performance. They unknowingly created too much compression on their nerves, which created drop foot, a limited range of motion.

[46:50] How do you provide holistic care? 

Dr. Swart recognizes that people come in with a specific compliant. Back pain, knee pain, etc. They are trying to solve a larger problem. Relieve knee pain to do…what? There are so many factors that come into that. Relationship development with the client is the piece needed to make recommendations. What are the stressors? Is it time management related? Is it sleep related? One night of sleep disrupted, can increase the acuity of pain and increases the chances of injury in athletes. He also thinks it is important to connect people to the right providers. It’s not always rocket science to figure out a client’s problem, look at the fundamentals of life. Dr. Swart makes the argument that health is set up on a set of pillars, if one thing is off, it can trigger a cascade of issues. The body is complex, the body does not work in silos. 

[53:00] The problem with insurance and PT 

Insurance will not provide most services at Dr. Swart’s clinic. So how do clients become willing pay out of pocket? He always asks, is it expensive, relative to what? Shoes, concert tickets, etc. Money is not finite. The value supports the cost. We don’t want to be a financial burden for anyone.  Because we give a high-quality service, what we do justifies our cost. My job is not to determine what your values are, if you want to spend money a different way, that is your value. Our company wants to care for patients. His team is small, 3 different PTs, two front end staff, a small company, but it is full of the most caring people. Athlete’s Potential gets most business from word of mouth and by the employees being present in the community.

[59:45] How the weight centric approach stops or slows progress 

David explains that weight gain is complex. Dr. Swart responses, you are selling your patients short, if all you focus on is one aspect, weight included. Fat can be a risk in surgery and it can cause joint pain. However, can we work on loading mechanics, strength training, to handle the load?  That is what Dr. Swart’s team is interested in. Pain is not going to magically go away just because weight is lost.

Dr. Swart knows larger sized people who have way more cardiovascular health than an average thinner person who does not strength train. It is so much more than BMI (body mass index) and external looks. Weight is too often used as an identifying factor of who we should be, which is a poor understanding of health.

Your body is an investment, you get one. Do you know how to take care of yourself and enjoy life? Everyone deserves that. Dr. Swart, and David’s practice, Orozco Nutrition, are selling how to add value in a person’s life. 

[1:08:15] Closing Announcements!

 Shout out to Jennifer Baugh, our newest RD, has been working behind the scenes on this podcast the last few episodes. She and Raegan Perkins, two RDs in the team, provide a ton of support for the podcast and the business, so thank you! We are going to be taking a short break, and recasting some really great episodes to guide us through the upcoming holiday season. When we come back, we are going to have an even better show, that really invites you to be in the conversation.

Make a free 15-minute phone call if you want to work with us on your nutritional health in a weight-inclusive, anti-diet culture way.  Get the ball rolling by emailing us at info@orozconutrition.com or call 678-568-4717.

Where do I go from here?

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Links from This Episode: 

• Dr. Jacob Swart’s clinic: Athletes Potential
• Athletes Potential Podcast: The Active Atlanta 

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