What Is Arthritis and Can It Get Better? A Physical Therapist Explains | Dr. David Sofer

Lisa [: 00:00:26

Yes, thank you for joining us today. My guest is David Sofer. David is going to help us understand arthritis, how to manage pain, and how to maybe distinguish between good pain and bad pain. And also some interesting information about posture, which I really haven't heard a lot on arthritis and posture. So I'm very curious to hear what information David has to share. Good afternoon, David. How are you?

David Sofer [: 00:00:56

I'm doing great. Thank you so much, Lisa. It's great to be here.

Lisa [: 00:00:59

Thank you. Where are you calling in from?

David Sofer [: 00:01:02

Brooklyn, New York.

Lisa [: 00:01:03

Okay. And how's the weather there?

David Sofer [: 00:01:06

We had some snow about three days ago, but it's starting to recede a little bit more on the way, but we're holding steady here.

Lisa [: 00:01:14

Wonderful, wonderful. So we are in the Midwest and I think maybe. Well, I don't want to say that because it might depend on where you are, but we. It wasn't as bad as they were saying it was gonna be so far. But it's supposed to snow for the next couple of days here, so hopefully our listeners are staying safe and well and warm and they get to stay home and do whatever it is they have to do. So tell us a little bit about yourself before we dive into everything you know about arthritis. Who are you and what have you done professionally in your life?

David Sofer [: 00:01:52

All right, so I'm David Sofer. I am a doctorate in physical therapy. I've spent the last 22 years working in the outpatient physical therapy world. I started in the realm of sports medicine. I was an athlete growing up and I was always kind of drawn to sports. But throughout my career, I started working with all different varieties of patients and I started to to find a lot of fun and success working with some of my older patients, especially with arthritic conditions. And I found that a lot of the principles that I was able to take with my sports medicine patients and my athletes, I could actually relate very comfortably and easily to the older population or the arthritic population, which may seem a little counterintuitive because people think arthritis and sports don't go together. But in the end, it all comes down to the principles of movement and the foundations of movement and the way you move.

David Sofer [: 00:02:55

The foundations of healthy movement are the same whether you're running a marathon or Walking to the kitchen. So by kind of breaking movement down to its fundamentals, I was able to take a lot of similar principles and bridge them between the athletic population and the arthritis population.

Lisa [: 00:03:11

David, you are a physical therapist, correct? And what you have discovered is that we as humans have a lot in common, regardless of our age. So that's a good thing. Talk to us about the pain that is typically associated with arthritis and give us some tips on how to manage it. Is it fair to characterize it as chronic pain?

David Sofer [: 00:03:37

Yeah. So chronic pain is any pain that lasts for an extended period of time, so for even two, three months. And the nature of arthritis is a progressive condition. So the structures don't heal over time, but that doesn't mean that you can't feel better over time. And so it is a chronic condition, and it is typified by pain in the joints. And usually, depending on the type of arthritis, there's lots of different types of arthritis. I'm going to speak more globally to osteoarthritis right now, which is more of the wear and tear type of arthritis. And the most common type, that you get some wearing away of the cartilage between the joint surfaces, and that can create stiffness, and that can create pain.

David Sofer [: 00:04:28

But what most people don't realize is if they can change the way that they move, if they can change the patterns behind their movements, we all kind of move with patterns and habits. That's the way our brain contextualizes the world, really. And if we can, sometimes we get looped into dysfunctional movement patterns, patterns that can cause irritation or inflammation in certain areas, and we can't really get out of them because we're absent to them. We don't even realize that they're occurring. We have no knowledge that they exist. And then once I can bring to my patients, I can bring to light that, oh, look, you're continually moving this way, which creates this pattern, which creates this strain that creates this pain. And then we teach them a new pattern to move, they rediscover that they can move in a different way. And the things that were once painful are no longer painful or significantly less painful.

David Sofer [: 00:05:20

They feel stronger, they feel more comfortable. By retraining these patterns, you can really change the way people feel, despite the fact that their arthritic joints are still going to remain arthritic.

Lisa [: 00:05:32

So in some ways, it's about awareness.

David Sofer [: 00:05:35

It's so much about awareness. There's really four stages of movement learning. So the first stage is unconscious inability. So you have no idea what you can and can't do. And you don't know that patterns exist or don't exist. And that's where most people are. Even me with a lot of the things I do, we don't realize how we move. And then when people come to see me, the first thing that I work on with them is creating what I then call conscious inability.

David Sofer [: 00:06:04

So they understand what they can and can't do, even if they can't do it yet. But first, that first step of understanding that conscious knowledge that there are two different types or three different types or however, different types of way to move and that they're moving in one way is the first step to making change. Without. Without awareness, there's no ability to change or improve. Then the third step becomes conscious ability. And that's when they can move in a certain way. They can move the comfortable way, but only when they really think about it. Only when they put all their focus to it.

David Sofer [: 00:06:40

It's not a habit yet, but they figured out the formula. It's just not their first intuition. And then finally the holy grail is unconscious ability. And that's when we are just able to move in a healthy, comfortable way without even thinking about it. And very often people can move on with unconscious ability on their left leg, but not so much on their right leg. You know, we're asymmetrical as creatures, so that process happens with us. And I try to take people from through that continuum as I'm working with them, to change their movement patterns and habits.

Lisa [: 00:07:17

How long does it take?

David Sofer [: 00:07:20

It is a process. Okay, so. And people take to it very differently. And it really depends on how ingrained your patterns are. People develop patterns for very good reasons. The body has wisdom. The body does what it does for good reason, even if it becomes symptomatic or harmful over time. So depending on how ingrained those patterns are and how self aware you are and how good you are at kind of understanding your own body and movement.

David Sofer [: 00:07:46

Will it take to go from one end of the spectrum to the other, but to go from unconscious inability to conscious inability? Sometimes that's just one session. It's just one epiphany. You're moving, you go, oh, I never realized. And then it's just there with you. And from that point on, you can move down that learning process. That's really the good first step. So it takes a while to get to the end of the road, but you make progress throughout every day that you practice.

Lisa [: 00:08:14

It's a great point. So it's not. You don't have to Be training for the Olympics. Right. You will see results as soon as you become aware and start thinking about it and trying to move differently.

David Sofer [: 00:08:28

Absolutely. As soon as you can understand what your habits are and then you can ought to change, progress will inevitably happen. And that happens with any movement learning process. If you think about, like, how long does it take to have the perfect golf swing, right? I mean, it takes people their entire career. Right. But if you take a lesson, you can certainly get better. Right. And you can shape getting your score.

David Sofer [: 00:08:48

So it's like that with any. Any movement process. Anything that we do. If you consider, like the first time I went to drive a car, you know, I was 18 and my driving lessons and everything was new to me, so I. It was so hard to focus. And now you've been driving for years and you're just so relaxed. Everything comes so easily. That's that unconscious ability that happens over time.

Lisa [: 00:09:08

But you ain't gonna get anywhere sitting on the sideline thinking about it, right?

David Sofer [: 00:09:12

Yeah. If you don't, if you don't engage, if you don't try, if you don't experiment with your body and you don't move, if you're fearful, and this is what people come to me with so much that really limits them. They've been told, I'm afraid, misinformation over time. They've been told that if they move, they're gonna hurt themselves and that if they feel pain, it means that they're doing damage. And this is by and large not true. It is not a blanket truth. I mean, yes, if you move in a bad way all the time, you may do that, but just because something hur. Should be a prompt for curiosity, right? That should be a prompt to be interested about, okay, what's going on here.

David Sofer [: 00:09:45

And then exploring and discovering within yourself how you can move differently, and then you can find the changes, and the changes are there. I've never met anybody who couldn't be better than they were the day that they walked in. We all have capacity for improvement and change.

Lisa [: 00:09:59

Well, and it's interesting that we're having this conversation because all of a sudden I'm having this little issue with my knee, and I am curious. I'm like, okay, what's really going on? And at first I thought it was the pair of shoes I was wearing. I wore a new pair of heels and I thought, okay, now I have gone way down on the heels. You know, there's like no more than two inches these days. Used to be a different story. When I was much younger but it ain't the shoes because it happened in the sneakers more recently. So I'm like, yeah, I am curious what's going on. And then that's going to motivate me to take more action and to get with some professional and have them look at it and tell me what they think.

Lisa [: 00:10:45

And then I might learn about some unhealthy movement habits that I'm set in my ways, like so many of us. And I might have to relearn some things, right? Because it could be arthritis. There really is a good chance. A lot of people in my family have it and I'm getting older. And here we go.

David Sofer [: 00:11:08

I mean, here it is. Arthritis is coming for all of us. All right? If you have the benefit of living long enough, you earn that badge, okay? So arthritis in and of itself is not an evil. And in fact, just fighting arthritic changes on x rays or MRIs is no indicator of pain. They are not correlated together. 50% of people who have arthritic signs on imaging have no symptoms whatsoever. So just because you have arthritis doesn't mean that you're condemned to pain. So I want to kind of de.

David Sofer [: 00:11:39

Threaten that word arthritis that, you know, I listen to so many people and I go on Facebook groups and talk to folks and they're all like, I was diagnosed with arthritis. I'm gonna buy a wheelchair now. Because I know that that's it, you know, it's coming for me. That's. I'm going down that road. And, and it. And they. And they get themselves worked up in such a.

David Sofer [: 00:11:57

Such a frenzy that they almost. It can become a self fulfilling, you know, thought process that if you feel like you're definitely gonna decline, then you will. But I'm telling you it's not the case. There is no inevitability, and there's always capacity to improve, even with conditions that the tissues themselves don't get better. You. Even if the tissues don't get better.

Lisa [: 00:12:19

Things change as we age, right?

David Sofer [: 00:12:21

Absolutely.

Lisa [: 00:12:22

It is almost a normal part of aging for many of us. Yeah.

David Sofer [: 00:12:27

No, it's not almost a normal part. It is a normal part of aging. It is part of aging. It's inevitable. Nobody, the healthiest human in the world doesn't look at 50 or 60 or 70 like they did when they were 20 or 30. But that's okay. That doesn't mean that you can't be healthy, productive, thrive, happy. And on my website, it's www.arthritishelp.info h e l p.inf o.

David Sofer [: 00:12:55

I have a whole library of videos that cover all areas of the body where people can start to understand this process. It's all free. You just go on and you check out the videos and articles where I have articles talking about my thoughts about all these things, and then videos 20 to 30 minutes long that introduce you to how to be better at getting up from a chair, or how to be better at going up the stairs, or how to be better at taking just a step, or even just how to be better at tilting your pelvis a few degrees back and forth. Because actually, that is such a crucial part of being able to transfer force down your legs. So if you want to learn more, if you're like, okay, some of these things make sense, I want to try it. You can go try it totally free, and then you can email me and let me know what you think. And I'm happy to talk to anybody who's curious about this because it's my passion.

Lisa [: 00:13:43

I was going to say, obviously this is a passion. A passion point for you because you don't have to do all this stuff for free and it takes a lot of time and energy. We'll be sure to link this podcast to your website and provide that information so people know how to find you. Are you still practicing as a pt? I assume you are.

David Sofer [: 00:14:04

Absolutely. So I practice as a pt. I teach physical therapy in two universities, and then on the side, I make these videos and I post them online for folks. It's something actually I started doing towards the end of COVID because. The end of COVID but hopefully the end of COVID within the last. Within the last year because I've had so many patients that were afraid to come out and they couldn't find. I couldn't find good resources online that could really help them, you know, move and train the way I wanted them to. Everything I found online was your typical, like, you know, exercises.

David Sofer [: 00:14:44

It wasn't moving, movement, retraining, focus, so I couldn't find it. So I made it myself, and now I use it for home exercise programs for all my folks.

Lisa [: 00:14:55

And I even love your word choice because I think exercise is intimidating, but movement is not. We all want to move, right?

David Sofer [: 00:15:05

Absolutely. And why not? But how much time have you ever put into thinking about how you move? Right. It's really kind of not a point of focus for people even. When have you ever gone to a physician and they looked at how you move? It's something that doesn't get anywhere near the credence that it needs from the laypeople and also from the professionals. We look at images, we look at tissues and what they look like, but that doesn't say anything as to how you use them. And analyzing movement is the only way to determine how people use their bodies. And if you change the way you use something, you change the way you feel.

Lisa [: 00:15:48

And one thing I know for sure from working with seniors for a number of years is mobility. Is everything absolutely more important than that driver's license, which I know we think that's a hard one to relinquish. But we don't have to give up on movement or you can't.

David Sofer [: 00:16:06

Movement is medicine. Movement is life. If you give up on movement, you don't, you know, you give up on. On your life, and you can't let that happen. And so you can be challenged, but you can get better.

Lisa [: 00:16:17

Yeah. Even people in wheelchairs, right. Like the one person or the example you were giving where the person said, oh, I got a diagnosis. I'm going to buy a wheelchair. Stop that silliness. But even for people who are in wheelchairs, there's still range of motion, and mobility is still important. It is part of being human. And this is really a different way of looking at it.

Lisa [: 00:16:41

So thank you. Thank you for this information. Hey, let's talk about posture for a minute.

David Sofer [: 00:16:47

Let's talk about posture.

Lisa [: 00:16:48

Yeah, what about it?

David Sofer [: 00:16:50

What about it? Okay, so posture first. I want to dispel the myth of good and bad posture. Guess what? There's no such thing as bad posture. There's no such thing as good Posture makes me happy. Yes. Yes. So often people feel so down about themselves. They come in, they say, I know my posture sucks.

David Sofer [: 00:17:06

I'm like, oh, why? You walked in, you're alive, you're sitting here, you're okay. It may not be perfect, but posture doesn't have an agenda. Right. It doesn't have intention. It's not good nor bad. It just is. And all posture is, is how your body is setting itself up to sustain itself, balance itself against gravity at this moment in time. And you choose a way to do that based on so many different things, based on your flexibility, based on your habits, based on your mood.

David Sofer [: 00:17:38

Right. You can look at someone's posture and see if they're happy or sad sometimes or confident or not. So posture changes. It's very changeable. And so the thing that I look for with posture is how are people managing to combat the downward forces of gravity that are always pushing upon them all day, every day? And do they do that in a way where the Force can get transmitted through their bones, through their skeleton. Right. Or does that force kind of go into, like, one area? Sometimes there are these almost movement funnels where the force kind of gets trapped in the low back or in the neck or in the hips, and that's where problems tend to arise. So I'm just trying to get people to distribute the downward force of gravity in a little bit simpler way.

David Sofer [: 00:18:26

Bones themselves, the skeleton, especially the long bones, have tremendous capacity to withstand downward compressive forces. Other tissues like tendons and ligaments, not so much. So if you can get your body to balance over your bones, you will feel much more comfortable. If you wind up letting some of that force go into tendons and ligaments, you're going to wind up having pain or strain at some point in time. So it's about realigning people.

Lisa [: 00:18:52

It sounds simple, but I don't know what you're talking about. Okay, let's do it.

David Sofer [: 00:18:57

All right, you want to do a little posture exercise with me right now. You want to do that. Is that okay with your listeners? Okay, if you're sitting right, we're gonna do a little sitting exercise. If you're not sitting, have a seat. If you're sitting, sit down right now. And as you sit, all I want you to think about is I want you to think about your butt and your butt bones and how they're connecting with the chair. Okay. How they're connecting with your surface.

David Sofer [: 00:19:18

And I want you to think about, are you sitting a little bit more towards your tailbone, or are you sitting directly on the center of those sit bones, those butt bones? Or if you like to arch your back, sometimes you sit a little bit on the front or even on the thigh bones. Most people have a little bit of a slouchy sit, and so they sit a little bit on the tailbone. Right. And that's okay for some amount of time. But the tailbone is not great at withstanding force, so that's going to put more stress on your back and your shoulders and your neck. So all I want you to do right now is to rock your pelvis forward and backward and kind of get a sense of the feeling of your sit bones as you rock forward and back. See if you can feel the back third of the sit bone, the center of the sit bone, the front third of the sit bone, and just rock back and forth a little bit and get a sense and feel how your body changes as you move. Now as you do that, I want you to just hone in and center down on the center point of your sit bones.

David Sofer [: 00:20:12

Right. That is your best base for most people, the best base for them to be able to withstand the downward forces of gravity from that point. If you actually press those center points of your sit bone, if you could figure out a way to press them into your surface, it makes your crown rise a little bit towards the ceiling. You don't need to be perfect. I want you to reject this military chest up, chin up posture. That's nonsense. That's putting you into a box that may not be for you. Find your base that is the center of those sit bones and see if you can just press down into the surface so that you rise up.

David Sofer [: 00:20:43

And once you learn how to press down, then you're no longer letting the downward force of gravity compress you. You're actually being powerful and pressing up against that force a little bit. Now, if you're thinking, there's no way I can do this and sit for a half hour, that's okay. Don't worry about that. Right. Because the key to good or healthy posture. I won't say good, healthy posture, is not to be in one perfect static position forever. That's also a fallacy.

David Sofer [: 00:21:11

There's no. This is the right position for me. It's to be able to find that position when you need to. So when you get tired, you fall into a slouch and your body can rest. And thank God for that. Okay. That the muscles can relax a little bit. But when that becomes strenuous, you need to be able to change.

David Sofer [: 00:21:27

So you notice that you hit the reset button. For me, the reset button is, where are the center of my sit bones? Oh, no, no, no. I need to put them right down to the surface. I rise up. Once I do that, I reset, all the stresses kind of go away and realign. And then I live like that until my brain goes somewhere else and I wind up in whatever my intuitive position is or posture is. But the ability to make subtle changes frequently will give you resilience and give you longevity of comfort in sitting. Or we could do something similar in standing or any other position.

Lisa [: 00:21:57

David, I didn't even know I had sit bones. Talk me through that. And we are on camera. We can see each other today even though the audience can't see us. And I did notice that I got a little taller, and I was. I definitely. I guess I leaned forward a little, which I guess is better than sitting on my tailbone. But that was great.

Lisa [: 00:22:22

Thank you. And the cool thing about a podcast, if you didn't get it, just Listen again, that exercise. So in a way, it is about finding your center. We hear people talking about that all the time.

David Sofer [: 00:22:37

And if you want to see me talk through that again on my website, my sitting position video, you can find that one. I go through that and a whole lot more. But it talks about powerful sitting and a smarter way to sit.

Lisa [: 00:22:49

And for those of us who are sitting a lot, especially right now, I normally travel in my job. I don't do. I did very little travel in January because of the virus. And I'm like, oh my God, this sitting is killing me. I want to go. So it's great information always, but maybe especially even more so during COVID

David Sofer [: 00:23:15

It comes down to. Everything comes down to not what you're doing, but how you're doing it. So I hear things these days like, sitting is the new smoking. And, you know, it just strikes me, it maligns sitting. Sitting is great. Sitting allows us to do so many things. If it wasn't so important, we wouldn't do it all the time. And so, yeah, you don't want to spend your whole life sitting.

David Sofer [: 00:23:34

But how you sit is as important, at least, if not more important than how much you sit. So if you take a moment to think about the how. Right. That's retraining the movement, then the what becomes less relevant.

Lisa [: 00:23:48

So really, it's nothing like smoking. Because how you smoke doesn't matter.

David Sofer [: 00:23:52

Exactly. It's only that you smoke, right? Absolutely correct. It's very different.

Lisa [: 00:23:58

Great, great information. I did want to ask you, though, I'm curious about this, about how people get diagnosed with arthritis. How does that happen?

David Sofer [: 00:24:10

So the diagnosis is pretty simple. By and large, what happens is somebody has an ache or pain in a joint of the body, they see the physician. The physician will often order an X ray and then the X ray will show narrowing of the joint spaces or maybe some changes to the bony morphology, like little osteophytes or bony protrusions here or there. And that will determine that the patient has arthritis. All arthritis means is some wearing or irritation, irregularity in the joint. But that is such a broad definition. It can encompass so many symptoms. And people like there are people that can have some arthritis and literally run marathons, and there are some people that have arthritis and they can't get out of a chair.

David Sofer [: 00:25:01

So just because you have been labeled with that doesn't mean that you are predestined or condemned to any type of outcome. And in fact, very often people wind up going for some ache or pain that is not arthritis related. At all. But then they get the imaging and the imaging shows arthritis, and they say, well, that must be it, right? They make the assumption that if the imaging shows it, that that's the cause of the pain. But that is very much not only the case. And more and more research that's coming out that's showing that asymptomatic people very often all the time, even more than half the time, show some irregularity on imaging because it is a normal and natural part of healthy aging or joint changes. So just because you have them just means that you've earned your wings to some degree on this earth for a certain amount of time.

Lisa [: 00:25:53

Okay, so in a way, arthritis is a good thing because it means you're still alive.

David Sofer [: 00:25:59

Yes, that's good.

Lisa [: 00:26:00

And you're aging. Aging is a good. And so now we just have to figure out how to manage it, how to compensate for whatever the pain is or the changes. And as you say, there's no good or bad posture. And even some things like sitting, which we all think, you know, for me, it drives me crazy because I want to go, go, go. But some people think, gosh, sitting's bad. Well, no, it just depends on how you sit. And this all starts with awareness.

Lisa [: 00:26:29

How am I doing? Am I getting your great synopsis?

David Sofer [: 00:26:32

I should record that and put it on my site.

Lisa [: 00:26:36

Well, David, thank you. This is really valuable information. I am sure that my listeners are going to appreciate it. Give us your website one more time. But as I said, we'll link it to the podcast.

David Sofer [: 00:26:49

Absolutely. It's www.arthritishelp.info info. Or you can find me at Just My Name, davidsoffer.com if that's easier for you. But our thread is help.info is where you find all this information.

Lisa [: 00:27:02

And sofer is spelled S O F E R for the. For our listeners.

David Sofer [: 00:27:07

Thank you.

Lisa [: 00:27:10

Any parting thoughts? Or did we wrap it up?

David Sofer [: 00:27:14

You know, as if the take home that I can. That I really want to give people is this idea of hope. Because really what I find when people either when they get the diagnosis or as they start to find that, that things in their life are changing because of arthritis, they're maybe less social or even it could be a little thing like, you know, it just hurts to get out of a chair now, they become less active. And then oftentimes from that there comes this demoralization and this feeling of inevitable decline. And I just want people to know that arthritis does not condemn you to disability. It does not condemn you to pain, that there is hope and there is possibility to improve. And if you give yourself the opportunity to learn new things and become more aware of how you move, you might just find a way to change your life. So if people can just take a little bit of that positivity home with them today, I'll feel so good about the message that we're giving out.

Lisa [: 00:28:14

Well, you should feel good, listeners. We got this. This is all about aging in full bloom, getting our minds around the changes that are in process or that are coming. And we can handle it. David, thank you so much. Hope you stay safe and stay warm and well and everything that's important right now for us all. Listeners, we hope you enjoyed the program and learned a little something along the way. I'm sure you did.

Lisa [: 00:28:40

Till next time. May the road rise to meet you. May the wind be forever at your back.