Today, I welcome a Q&A with Mitchell Yass, PT. Mitchell is a well known Long Island physical therapist who specializes in using resistance training to overcome many forms of chronic pain, including back pain, sciatica and neck pain. Mitchell has recently published a book on his experience in treating a variety of health complaints and sent me a copy for review.
As all of you know, I carefully select literature for inclusion on this site and only present materials I feel are helpful to the readership. Although I am not overly enthusiastic about physical therapy for most forms of chronic pain, I do recognize its incredible applications for rehabilitating injury and post surgical patients. That being said, I like the fact that Mitchell’s approach is very different and may have some true benefit to many of you still suffering in pain.
As a trainer myself, I particularly enjoyed his section relating the hamstrings to lower back pain, as this is an issue I have personally endured. Many patients are surprised to learn that tightness and the lack of a full and functional range of motion are not stemming from their back muscles at all, but rather from the hamstrings. This is also one of the weaknesses of the so called “straight leg raising test” used so often in back pain diagnosis.
Although my view on back pain treatment may differ from Mitchell’s, we both agree on one important thing… Back pain is a mostly misdiagnosed condition which is typically blamed on coincidental spinal abnormalities. Although these structural issues may exist, they are not the source of pain in most patients and alternate treatment options, such as back exercises and knowledge therapy have both proven their effectiveness when the traditional medical approach to relief usually fails… miserably.
Mitchell Yass Q&A
Q: Can you give my readers a brief synopsis of your book, Overpower Pain?
A: The book is designed to present to the reader a brief understanding of how I determine whether the cause of pain is due to a structural abnormality like arthritis, stenosis, a herniated disc or a meniscal tear, versus a muscle weakness such as a strain or muscle imbalance. Unfortunately, the majority of causes of pain are diagnosed to be structural simply through the findings of diagnostic tests. Understanding that every symptom results from a specific cause seems to be left out of the diagnostic equation. I have proven that the cause of pain is most often muscle weakness or imbalance even when the findings of structural abnormalities are identified. With this understanding, I demonstrate and describe the most effective strength training exercises to perform to resolve pain at each joint of the body including the neck and lower back. I have received tremendous feedback from readers to date both on the theory of my method and effectiveness of performing the exercises presented.
Q: What are your professional credentials?
A: I have a bachelor’s degree in physical therapy from the State University of New York at Downstate. I am completing my Doctorate of physical therapy from the New York Institute of Technology by the end of 2009. I have owned and operated PT2 Physical Therapy & Personal Training in Farmingdale, NY since 1997.
Q: How and why did you first get into resistance training?
A: My understanding and experience in resistance training is extremely personal. I was a very thin child. I had a severe self esteem problem and even perceived myself as a Picasso painting with two eyes on one side of my head. I walked around always feeling intimidated fearing I would be tormented by other boys. When I was nineteen I tried weight lifting for the first time but was unable to put muscle on due to my metabolism. At twenty six I finally began to put muscle on. For the next consecutive four years I put on ten pounds of muscle a year. When I started I was 160 pounds. After these first four years of weight lifting, I reached 200 pounds. This was a dream come true for me. I changed my life and my perception about myself both inside and out due to my dedication to achieve this goal. I am now approaching 220 pounds still with the same waist size I started with. During this period, I played with weight lifting techniques acquiring an understanding of the physics laws that guide how to most effectively perform them. This helped me be able to use weight lifting for my patients when I recognized that weight lifting was the only real avenue to resolve pain in most cases. So between my personal revelation that commitment achieves goals, that pain whether physical or mental can be overcome with the right approach and my understanding of biomechanics and physics of weight lifting which I developed on my own, has led me to now take a little bit of myself and transfer it to every patient I come in contact with.
Q: Have you ever suffered from a chronic pain condition yourself?
A: I have never had a chronic pain condition. I do suffer from sinus issues. The problem produces migraine headaches which are very painful and has put me in a hospital on a couple of occasions but the problem usually diminishes in a day or so. My ability to empathize with my patients comes both from the pain I experienced growing up with severe low self esteem and the sheer numbers of patients I have treated with chronic pain. If you spend as much time as I have with people in pain at the level that they have become addicted to pain medication or are incapable of getting out of bed, you begin to feel like you are experiencing their pain.
Q: How do you feel weight training helps with various common pain conditions?
A: I have proven that the cause of pain in most cases is muscle weakness or imbalance; even when the pain is experienced in a joint. If someone has pain at the shoulder, an x-ray is taken and arthritis is found and becomes the supposed cause of the shoulder pain. The problem with this is that studies have shown that as many people with no pain have arthritis in the shoulder as those with pain. Secondly, it is critical to understand that arthritis is not an inflammatory response. It is a mechanical wearing of the joint surfaces which ultimately wears away the cartilage at the end of bones in joints and leaves bone available to touch bone. In rare cases this can lead to either bone developing in the joint to where no joint space remains or where bone is eaten away. These cases are where arthritis can cause pain but this is maybe 2% of all cases of shoulder pain. The other 98% of cases are where some muscle has strained that is involved in causing the joint surfaces of the shoulder joint to not be aligned properly. This causes the joint surfaces to rub in a way that creates irritation and pain. Weight lifting is the only method for achieving proper strength of all the muscles that are responsible for shoulder joint function to be achieved. This approach can be seen with every joint of the body including the neck and lower back. I have resolved patient’s pain in a few days or weeks by simply identifying which muscles need to be strengthening and then utilizing weight lifting to achieve the goal.
Q: Why do you think misdiagnosis is so common in the medical industry?
A: The answer lies in the education of most of the medical community including physicians, chiropractors and physical therapists. They are taught in school that the cause of pain stems from structural abnormalities that are identified through diagnostic tests like x-rays, MRIs and EMGs (electromyography). If the primary entry point that an individual begins care through establishes the cause of their pain to be found simply through diagnostic tests and nobody throughout the rest of the care the individual receives is capable of having an alternative viewpoint, then the care given will always be based on the false premise derived from the initial point of care. The issue I have with the existing system is that nobody seems to listen to the patient. I have had thousands of patients describe symptoms to me which could never result from the diagnosis established initially and yet treatment continued through multiple practitioners based simply on the initial diagnosis. When I focus my attention on identifying the cause of their pain by determining what cause can create the specific symptoms the individual is describing, they tell me I am the first person to listen to them. I believe this is the thing that most frustrates and enrages people about the way they are treated in the medical system when it comes to pain.
Q: Why do you think that spinal abnormalities, such as herniated discs and osteoarthritis, are often implicated as the source of chronic back pain, when all the research proves otherwise?
A: There is a basic falsehood that permeates throughout most of the medical establishment that the cause of pain can be found on diagnostic tests irrespective of the symptoms described by the patient. It is critical for people to understand that herniated discs, arthritis, stenosis and meniscal tears can exist and not cause pain. They can also exist and an individual can have pain in the area of the structural abnormality but something such as muscle weakness or imbalance can be the cause of the pain. The best example of a misdiagnosis being propagated by the medical community is that sciatica results from a herniated disc. Sciatica is inflammation of the sciatic nerve which runs from the gluteal region to the back of the knee. The true cause of sciatica is impingement of the sciatic nerve by the piriformis muscle in the gluteal region. I have close to a 100% success rate in resolving sciatica by addressing the inflammation of the piriformis muscle and resolving it through strength training of the muscles that work in conjunction with the piriformis muscle. A herniated disc impinging on a nerve root in the lumbar region would only cause an altered sensation in the area of skin that is innervated by the nerve root. NO single nerve root or group of nerve roots has ever been impinged to create sciatic symptoms. In fact, the sciatic nerve derives from seven nerve roots. It just doesn’t work like that in real life. In terms of research, the latest studies are showing that there is no correlation between the findings of diagnostic tests and pain. In fact, an article in the New York Times described many physicians even questioning whether MRIs should be used in identifying the cause of back pain because of the lack of correlation between the findings and back pain.
Q: What are your thoughts on how the mind influences chronic pain? Do you subscribe to the theory of mind/body medicine?
A: The first thing I would say about chronic pain is that in most cases, chronic pain is the result of misdiagnosed acute pain. I say this with a record of resolving thousands of patient’s pain that they experienced for multiple years in just a few weeks or months by determining the true cause of their pain. Having said that, I believe there is definitely a connection between the mind and its influence over pain. There are innumerable accounts of people being able to withstand severe pain due to control from their mind. I believe outlook on life is a factor. If an individual believes that there is an end point to the suffering they experience, this could lead to a sense of calming which can decrease the level of pain being experienced. I believe the rise in the number of people suffering from chronic pain is not an accident. It is the result of the medical community’s unwillingness to accept that they are failing under the existing system and that a new approach needs to be engaged. Studies are showing that surgical procedures such as the injection of bone fractures with cement or debridement of the knee joint to resolve arthritic changes of the knee to resolve pain yield no better results than a placebo surgery. This can not be a bigger wake up call and yet these procedures continue to be performed. Pain will only be resolved when there is a direct correlation between the cause of the pain and the pain experienced. The treatment for this type of understanding will yield results in the 90% to 100%.
Q: Who are the people who have most influenced your work and why?
A: The person who most influenced me is my father. When I was just a boy, I sensed my father was the smartest person I knew and I wanted to be just like him. He taught analytical thinking when I was 10 or 11 years old. He taught that logic is the essence of truth. He convinced me to never accept what is stated or written just because it is stated or written. When I entered the field of physical therapy, I sensed right from the beginning that many of the theories and methods employed had little to no logical basis. Once treating patients, it became even clearer that this was the case. I combined my ability to utilize logical analysis with my personal understanding of the physics and biomechanics of weight lifting and began to explore the idea that the cause of pain was due more to forces on muscles, tendons and joints more than some variation of the structures of these tissues. I developed an understanding of how posture and movement could help identify which forces were varied from the norm and how this played a role in creating pain. I utilized my understanding and personal experience in weight lifting to correct muscle weakness or imbalances. This is how I created and enhanced my method of understanding through out my career. I am now in a position where I am getting requests around the country to open facilities or bring my method in other formats. I am excited by the prospect of teaching other therapists my method and bringing my success to them in a continuum from the first days where my father was teaching me that logic leads to success.
Q: What do you have to say to the many critics who would question your recommendation of using weight training as a means of treating lower back pain, especially with such ill reputed exercises as the dead lift and the squat?
A: The first thing is that I have unequivocal proof that the cause of most lower back pain is the result of muscle weakness or imbalance. The critics have absolutely no understanding of this premise so their criticism is based on lack of education. I have not met one person who I have had an interaction with who didn’t agree that my method was logical and makes complete sense as to why they are experiencing pain. Let me make this perfectly clear, I am not saying that my method is an alternative to the existing system which identifies the cause of pain through diagnostic tests and promotes medications, epidural nerve blocks or surgeries based strictly on the premise that no other treatment worked. I am saying that my method is the method for properly identifying the cause of pain. If the cause is a structural element, then I endorse surgery to be performed immediately to resolve the cause of pain. I have found however that in 90% to 95% of cases, the cause of pain is muscular and the only thing that can resolve this is strength training. Here are a few facts to prove my success. 25% of all my patients come to see me without seeing a physician first. This is called direct access and is a law in New York. 1/3 of all of my patients pay cash. These are people who many times have insurance but would rather come to me through direct access which can only be paid by the individual than continue in the existing medical system. 99% of all my patients are obtained through word of mouth. 50% of my patients are willing to drive at least one hour to receive treatment from my office. As more demand continues for my method, I expect to open offices nationally and probably internationally.
Q: How do you address the criticism you must get from professionals who would view a self training program such as the one in your book as being incredibly dangerous for unsupervised patients?
A: It is important to understanding that I am not suggesting that everybody can resolve their pain on their own. A person bed ridden from pain cannot perform a strength training program unsupervised. First, the cause of pain must be determined to be muscular. Then, the person needs some form of guidance to perform the proper and effective exercises to strengthen the muscles that will resolve their pain. The person must be able to perform the exercises without having pain. If this cannot be achieved, then a supervised program is necessary. There are substantial numbers of people who can benefit from this type of information and can resolve their pain with the type of guidance presented in my book or on downloadable videos that I provide through my website at www.mitchellyass.com. If someone is capable of resolving their pain in this manner, why have them spend healthcare dollars to receive treatment that is unnecessary? I have received tremendous feedback from those who have read my book and in fact resolved their pain by following the exercises provided in it.
I sincerely thank Mitchell Yass for participating in this Q&A and I recommend his book for all who are interested in a holistic and positive approach to overcoming back pain.