Episode 74

How to Be as Resilient as Your Dog (Neurosurgeon Explains)

33:32 September 29, 2026 By Dr. Ravi Kumar MD
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Show Notes

A stick tumbled end over end, Blue ran into it with his mouth wide open, and his soft palate tore from the roof of his mouth all the way back to his esophagus. In a human, that is major surgery, a breathing tube, days on a ventilator, and a feeding tube. Blue went home that night and tried to fetch.

That is where this solo episode starts. Dr. Ravi Kumar has spent his career looking at injuries to the head and neck, and when the emergency vet showed him the torn tissue in the back of his border collie’s throat, he knew it was a big one. The vet placed about ten interrupted sutures, sent Blue home with instructions to eat soft food, and two weeks later he was running, eating, and wagging his tail as if nothing had happened. Ravi could not stop thinking about how that was physiologically possible, and he splits the answer into two halves: the things a dog has that we simply cannot have, and the things we can actually copy.

The first half is anatomy. In a human, the larynx sits halfway down the neck, and the pharynx above it is a shared hallway for air and food. Every swallow depends on the larynx pulling up and the epiglottis folding down like a trapdoor, and when that machinery is swollen, damaged, or sedated, food and saliva end up in the lungs. That is why a person with a torn throat gets a breathing tube. A dog’s larynx sits practically at the back of the mouth with the epiglottis tucked up behind the soft palate, so food travels around it on either side and the airway stays sealed off. Blue tore the roof over the food road without ever opening a crossroads into his lungs.

We all had that setup once. A newborn’s larynx sits high, which is how a baby can nurse and breathe at the same time. Over the first couple of years the larynx drops into the neck and stretches the pharynx into a second resonating chamber at a right angle to the mouth, with the tongue sitting at the corner where the two meet. That two chamber instrument is what lets us say ee, ah, and oh. A dog, with one short chamber, can bark, whine, and growl but cannot form a vowel. Speech was the trade, and the sealed airway was the price. Gravity adds one more difference: a dog’s head hangs out in front of the body, so blood and swelling drain forward and out of the mouth, while ours pool straight down onto the airway.

Then there is the tissue itself. Bite the inside of your cheek and it is gone in two days with no scab and no scar, while a cut the same size on your arm leaves a mark for years. Oral mucosa keeps much of its fetal healing programming for life: a smaller, shorter inflammatory response, fewer myofibroblasts, fast turnover of surface cells, and collagen laid down slowly in an organized pattern that matches the original tissue. It also heals in a wet environment bathed in saliva, which carries growth factors, lysozyme, and antibodies. Dogs add a more alkaline saliva and a mouth that never stops moving, so nothing stagnates long enough for infection to take hold.

The second half is what we can borrow, starting with movement. Ravi admits that early in his career he told post surgical patients to take it easy for a few weeks, and it took him longer than he would like to admit to learn what tissue actually wants. Cartilage has very little blood supply and feeds by being squeezed and released like a sponge, so stillness starves it. Muscle measurably atrophies within a week of immobilization. Tendons lay down collagen along the line of gentle pull, and heal into a weak random tangle without it. Bone follows Wolff’s Law, thickening along lines of stress, which is the whole logic behind plates and rods: hold the fragments in alignment so the patient can get up and load the bone. Spine fusion patients now walk the same day, and in 2022 The Lancet published the FORCE trial, across 23 UK hospitals and almost 1,000 children, showing that buckle wrist fractures did essentially as well with a soft bandage and no follow-up x-rays as with a rigid cast. Ravi is careful about the limits: an unstable fracture or a fresh tendon repair still needs rigid protection, full stop. The real question is what exactly are we protecting, and can we protect just that while the rest of the body keeps moving.

The last piece is pain. Blue never whimpered once. Part of that is masking, a survival habit from animals that were both hunters and hunted, but part of it is real, and Ravi explains it by splitting pain into nociception, the raw signal from damaged tissue, and suffering, what the brain does with that signal. Humans are spectacular at catastrophizing, attaching a future to a sensation, and that has been measured to raise reported pain, slow surgical recovery, and increase the odds of chronic pain. A trial at the University of Colorado Boulder gave 151 people with chronic low back pain a four week course of pain reprocessing therapy, and two thirds ended up pain free or nearly pain free versus about a fifth on usual care, with most of that relief still present a year later and visible changes on functional MRI. Ravi closes with a caution: being more like your dog does not mean ignoring an injury. Dogs hide problems until they are septic. The goal is the middle ground: notice it, get it properly assessed, and then drop the story.

Episode Resources

In this episode, you will discover:

  • Why a torn throat is an ICU problem for us and a same day problem for a dog: A dog’s larynx sits high with the epiglottis tucked behind the soft palate, so food and air travel mostly separate roads and an injury to the roof of the mouth never opens into the lungs
  • The trade we made for speech: Our larynx descends into the neck in the first couple of years of life to build a second resonating chamber for vowels, and the price is a shared crossroads that makes us choke, aspirate, and sometimes need a breathing tube after trauma
  • Why babies can nurse and breathe at once: A newborn has a high, dog-like larynx that seals the airway while milk flows around it
  • Gravity is on the dog’s side: A head held out in front of the body drains blood and swelling forward and out of the mouth, while ours pool straight down onto the airway
  • Your mouth heals like fetal tissue: Oral mucosa keeps fetal style healing programming for life, with less inflammation, fewer scar forming myofibroblasts, and organized collagen, which is why a bitten cheek heals in two days with no scab and no scar
  • Saliva is a healing fluid: It carries growth factors that tell cells to divide and migrate, lysozyme that punches holes in bacterial cell walls, and antibodies
  • Immobilization starves cartilage: With almost no blood supply of its own, cartilage feeds by being squeezed and released like a sponge, so weeks of stillness thin it rather than rest it
  • Muscle loss after a cast is caused by the cast: Atrophy starts within days of immobilization and is measurable within a week
  • Tendons heal in the direction you pull them: Gentle, repeated tension lines new collagen up like iron filings in a magnetic field, while no pull at all leaves a weak, random tangle
  • Wolff’s Law and why surgeons use hardware: Bone thickens along lines of stress, so plates and rods hold fragments in alignment and let patients load the bone instead of wasting for six weeks
  • The FORCE trial: A 2022 Lancet trial across 23 UK hospitals and almost 1,000 children found buckle wrist fractures did essentially as well in a soft bandage as in a rigid cast, and it changed national guidelines in the UK
  • When rigid immobilization is still the right call: Unstable fractures, fresh tendon repairs, and the first few days after some surgeries still need protection, full stop
  • Pain has two layers: Nociception is the raw signal from damaged tissue, and suffering is the meaning the brain attaches to it, which can turn the volume up or down
  • Catastrophizing is measurable: Attaching a future to a sensation increases reported pain, slows recovery after surgery, and raises the odds the pain becomes chronic
  • The pain reprocessing therapy trial: In 151 people with chronic low back pain, a four week course left two thirds pain free or nearly pain free versus about a fifth on usual care, and most of that relief held a year later
  • Why dogs mask pain, and why you should not: Animals that were both hunters and hunted learned to hide injury, which is why dogs often reach the vet septic and why there is no gold medal for skipping proper care

Key Takeaways

Some of a dog’s resilience is simply anatomy. A high, sealed larynx and a head that drains forward make a throat injury far less dangerous for a dog. We gave that up to gain speech, and we cannot get it back.

Your mouth already shows you what scarless healing looks like. Oral mucosa runs a calmer, fetal style repair program in a wet, saliva bathed environment, which is why mouth injuries close in days without a scar.

Healing tissue wants load, not stillness. Cartilage starves, muscle wastes, and tendons heal weak when they are held perfectly still. For most injuries that have been assessed and are stable, gentle and regular movement is part of the treatment.

Ask what exactly is being protected. The useful question is never movement versus no movement. It is which specific structure is at risk, whether it can be protected on its own, and whether the rest of the body can keep moving.

Respect the short list of real exceptions. Unstable fractures, fresh tendon repairs, and the first days after some surgeries need rigid protection. Listen to your doctor on those.

Pain is a signal plus a story. The signal comes from the tissue. The story, how bad is this, what does it mean, will it get worse, comes from the brain, and it changes how loud the signal feels.

The story is trainable. Pain reprocessing therapy showed that people can learn to notice a sensation without attaching a forecast to it, with lasting relief and measurable changes in the brain.

Be like your dog, but not all the way. Dogs hide injuries until it is too late. The middle ground is to notice pain, name it plainly, get it properly assessed, and then move as much as is safe without writing a catastrophe around it.

Transcript

[00:00 –> 00:16] Dr. Ravi Kumar: About a week ago, my dog Blue was doing the thing he loves the most in this world. He was chasing a stick. He’s a border collie, so he loves to fetch. And when I threw the stick, it did what sticks sometimes do. It started tumbling end over end.

[00:17 –> 00:45] Dr. Ravi Kumar: And Blue ran straight into it with his mouth wide open. The point of the stick went into the back of his throat, and it didn’t just poke him. It tore his soft palate from the roof of his mouth straight back all the way down to where the throat becomes the esophagus. This was Friday evening, of course, so I rushed him into the emergency vet who put him under general anesthesia to take a look. And when she showed me, my stomach just completely dropped.

[00:45 –> 01:27] Dr. Ravi Kumar: I’ve spent my whole career looking at injuries to the head and neck, and I immediately knew that this was a really big one. And here’s what I was thinking as soon as I looked at the destroyed tissues in the back of Blue’s throat. If a human being came into our emergency room with that injury, a traumatic tear from the palate to the top of the esophagus, they would be rushed in for major surgery, followed by a long ICU stay, intubated, that’s a breathing tube, and on the ventilator for a few days to protect the airway. Then they’d have a feeding tube, because swallowing would probably be impossible, and then weeks of recovery with swallowing rehabilitation. That’s not me being dramatic.

[01:27 –> 01:48] Dr. Ravi Kumar: That’s what an injury like this does to a human being. So what did the vet do? Well, she just sewed it up. She put it in about ten interrupted sutures all the way down his throat to his esophagus, and then he went home that night with instructions just to eat soft food. And two weeks later, he’s basically normal, running, eating, wagging his tail.

[01:48 –> 02:24] Dr. Ravi Kumar: If you met him today, you would never know that anything happened to him. Not only am I completely amazed at Blue’s resilience, but I haven’t been able to stop thinking about how this could be physiologically possible. Because that difference between the ICU stay for days or weeks for a human being versus going home the same day for Blue is not just a story about a tough dog. It’s a window into what resilience actually looks like in an animal that doesn’t contemplate their demise like human beings do. Now, there are parts of being a human being that we are just stuck with.

[02:24 –> 02:44] Dr. Ravi Kumar: It’s the way we’re made. But if we can understand the biology and the psychology of rapid recovery from major injuries, I think we can use that to become more resilient creatures ourselves. So that’s today’s episode. I guarantee you’ll never hear another podcast like this one, folks. So stick around, it’s gonna be awesome.

[02:45 –> 03:09] Dr. Ravi Kumar: My name is Dr. Ravi Kumar. I’m a neurosurgeon in search of the causes of human illness and the solutions that help us heal and thrive. I want you to join me on a journey of discovery as I turn over every stone in search of the roots of disease and the mysteries of our resilience. The human body is a mysterious and miraculous machine with an amazing ability to self heal.

[03:09 –> 03:24] Dr. Ravi Kumar: Let us question everything and discover our true potentials. Welcome to The Dr Kumar Discovery. Welcome to The Dr Kumar Discovery. My name’s Dr. Ravi Kumar.

[03:25 –> 03:52] Dr. Ravi Kumar: And today, we’re gonna jump into the science of how we can be more like our dogs. So we’re gonna do this in two halves. In the first half, I’m gonna walk you through the things that a dog has that we just can’t have, like their anatomy and the way their tissues heal. And some of it, honestly, was an evolutionary trade that we made on the way to becoming humans, and we traded it for very important things, and I’ll explain that later. In the second half, I wanna talk about the things that we can have.

[03:52 –> 04:12] Dr. Ravi Kumar: How a dog handles movement after an injury, how a dog handles pain, and why I’ve come to believe our whole paradigm around rest, splinting, and protecting an injury deserves a hard second look. So one more thing before we dive in. I gotta give a disclaimer. I’m a doctor, but I’m not your doctor. This show is for informational purposes only.

[04:13 –> 04:35] Dr. Ravi Kumar: Everything you learn today is meant to empower you. So take this knowledge, ask better questions, and work with your own doctor to build a healthier life. And just to be clear, this show is separate from my role as assistant professor at UNC. And also one quick favor. This show has grown to about 150,000 listeners a month, and every bit of that came from people like you, and I’m super appreciative.

[04:36 –> 05:05] Dr. Ravi Kumar: If you loved today’s episode, or maybe you just like it, leave a rating, drop a comment, or share it with someone you love or are friendly with who could be entertained or educated by this content. It helps the algorithms find and recommend this show to even a bigger audience than what we have. So please help me, and I’d be super appreciative. And lastly, you guys know I’m a neurosurgeon. Well, I’ve created an app that exercises the different domains of our brain through gameplay.

[05:06 –> 05:31] Dr. Ravi Kumar: It’s really cool and really fun, and it’s called braingamer.app. So it’s brain gamer, braingamer.app. You can go to that URL in any browser, on your phones or on your desktop, and it’ll open up the game. It’s free to play, and there’s a paid option if you want unlimited play. But what the app does is actually exercise each part of your brain and very intentionally.

[05:32 –> 05:48] Dr. Ravi Kumar: I play it every morning when I wake up, and the game is truly fun. It actually doesn’t feel like work at all. So I’d love the support. Please check it out, go to braingamer.app, play a game, share the results with your friend, and let me know what you think. Alright, let’s get into it.

[05:48 –> 06:07] Dr. Ravi Kumar: So let’s start with the part of being human that we can’t change. Why is a torn throat an ICU problem for you and me and a same day problem for a dog? The first answer is anatomy, and specifically, it’s about where your voice box sits. Let me take you on a little tour. Put your finger right here on your Adam’s apple.

[06:07 –> 06:31] Dr. Ravi Kumar: It’s this hard lump in the middle of your throat. That’s your thyroid cartilage, which is part of your larynx, also called your voice box, and inside it are your vocal cords. Now notice where it is. It’s down in your neck, like halfway down your neck, and it’s well below your jaw, well below the back of your tongue. And between the back of your mouth and that voice box, there’s a long vertical tube called the pharynx.

[06:32 –> 06:54] Dr. Ravi Kumar: Everything passes through that hallway. Air coming in through your nose or mouth on the way to your lungs, food and water on the way down to your stomach, they share the same corridor for a few inches. And then at the bottom, they split. Air goes forward into the larynx and the windpipe, and food goes backwards into the esophagus. That shared corridor, your pharynx, is a crossroads.

[06:54 –> 07:21] Dr. Ravi Kumar: And every time you swallow, your body has to close the road to your lungs for a split second so food goes down the right way. Your larynx actually pulls up, and a little flap called the epiglottis folds down over the windpipe like a trapdoor. And the food then slides back and goes into the esophagus. Then the trapdoor opens back up and you breathe again. You do this hundreds of times per day and without even thinking about it.

[07:21 –> 07:52] Dr. Ravi Kumar: And when that machinery gets damaged or swollen or a person is sedated, food and saliva can go down the windpipe and cause something called an aspiration pneumonia. That’s why humans with a torn throat get a breathing tube, because the anatomy can’t be trusted to protect the airway. Now look at a dog. A dog’s larynx sits way up high, practically at the back of the mouth. And the epiglottis, that little trapdoor structure that closes off the windpipe, it doesn’t just hang loose in the pharynx.

[07:52 –> 08:14] Dr. Ravi Kumar: It actually reaches up and tucks up behind the soft palate. So when a dog is at rest, the airway is essentially protected. Nothing from the mouth is going to seep into the airway. When a dog actually swallows, food goes around the larynx, on either side of it, and into the esophagus. So there’s barely any crossroads like we have in our pharynx.

[08:14 –> 08:34] Dr. Ravi Kumar: The two roads are mostly separate. So when Blue tore his throat open, he damaged the roof over the food road. He did not open up the crossroads into his lungs because he barely has one. His airway stayed protected because it was never sharing space with the injury in the first place. Now here’s the part that I think is really cool.

[08:34 –> 08:57] Dr. Ravi Kumar: Every one of us had that same setup at one time in our lives. A newborn baby has a high larynx, just like a dog. That’s why a baby can nurse and breathe at the same time. The airway is sealed off, and the milk goes around the larynx and into the esophagus. And then, over the first couple years of life, your larynx drops.

[08:57 –> 09:16] Dr. Ravi Kumar: It descends into the neck, and the reason it drops is for the purpose of speech. Now think about what a voice actually is. Right now, you’re hearing all sorts of complex sounds coming out of my mouth. And they’re coming from the vocal cords, but those vocal cords are just buzzing. They’re not doing much else than that.

[09:16 –> 09:52] Dr. Ravi Kumar: They sound kinda flat, kind of like a hum, or maybe like the sound that comes from a kazoo. And what turns that into words is the shape of the space above them. When your larynx dropped down into your neck, it stretched out that pharynx into a long resonating chamber, a vertical tube sitting at a right angle to the horizontal tube of the mouth. So you basically have two resonant tubes joined at a corner, and your tongue sits right at the corner where they meet. So your tongue can shape both chambers independently.

[09:53 –> 10:13] Dr. Ravi Kumar: Push it forward, and you get ee. Pull your tongue back, and you get ah. Round the lips and pull the tongue back and you get oh. Each vowel you’ve ever spoken is your tongue sculpting two chambers at once. A dog has just one short chamber and a tongue that mostly just moves from front to back.

[10:14 –> 10:32] Dr. Ravi Kumar: He can bark, whine, growl, but he can’t say ee or ah. The geometry of his airway just won’t let him. So that was the trade. Somewhere in our genetic and evolutionary ancestry, the larynx came down. We gained the two chamber instrument that can produce speech.

[10:32 –> 11:11] Dr. Ravi Kumar: But to do so, we gave up the sealed airway. And we’ve been choking, aspirating, and more recently, going to the ICU with throat injuries because of that anatomical design. So every time you talk to someone or sing your favorite song, you’re using the thing that makes your airway more susceptible to injury. Now there’s also one more anatomical piece here that helped Blue recover so quickly, and that is that a dog’s head is out in front of his body horizontally. When there’s blood or saliva or swelling in the back of their mouth or in the roof of their mouth, gravity pulls that fluid forward and out the mouth.

[11:12 –> 11:31] Dr. Ravi Kumar: Our heads sit on top of a vertical neck. Whatever pools in the back of our throats pools right down on top of your airway. And that’s not a small thing when you’re hurt, especially if you’re unconscious, drugged, or maybe the epiglottis is not working properly to seal off the airway. Okay. So that’s the anatomy, and let me sum it up.

[11:31 –> 12:03] Dr. Ravi Kumar: A dog heals a throat injury at home because his voice box is high and sealed off. His food and air travel mostly in separate roads, and gravity works in his favor to pull blood and fluid away from the airway. We can’t change any of that as human beings. It’s the price of our anatomy which allows us to speak. Now, let’s talk about the tissue itself in the mouth, because there’s a second reason that the vet was so relaxed when she saw this injury, and it has to do with the kind of tissue that got torn.

[12:03 –> 12:17] Dr. Ravi Kumar: If you’ve ever bitten the inside of your cheek hard enough to bleed, you realize something very interesting. Two days later, it’s usually healed and gone. There’s no scab. There’s no scar. Compare that to a cut on your arm that’s about the same size.

[12:18 –> 12:33] Dr. Ravi Kumar: That’ll take a week or two to heal, and it leaves a mark that you can see for years or more. That’s a scar. It’s the same body. It’s the same blood supply, but there’s wildly different healing between your skin and the mucosa in your mouth. So why is that?

[12:33 –> 13:01] Dr. Ravi Kumar: The tissue that lines your mouth or throat is called mucosa, and mucosa heals more like fetal tissue than it does like adult skin. And that’s not a figure of speech. Fetal tissue that I’m talking about is the skin or tissue of a developing baby in the womb, and it heals with no scar tissue at all. Scientists have been studying this for decades. And it turns out that oral mucosa keeps a lot of that genetic fetal programming running for you for your whole life.

[13:02 –> 13:32] Dr. Ravi Kumar: And here’s the difference mechanistically. When you cut your skin, your body panics a little. It floods the area with inflammatory cells. It calls in these specialized cells called myofibroblasts, which basically lay down fibroblasts with muscle cells, and its job is to grab the edges of the wound and pull it together, and then dump collagen into the gap as fast as possible. It’s truly a speed over beauty process, and the collagen goes down thick in disorganized bundles, cross linked and stiff.

[13:33 –> 13:48] Dr. Ravi Kumar: That’s what we call a scar. It’s strong, but it’s not the original tissue. It’s essentially a very durable patch. Mucosa does something much calmer. The inflammatory response is smaller and shorter, and less of those myofibroblasts show up.

[13:48 –> 14:21] Dr. Ravi Kumar: The surface cells at the edge of the wound start crawling across the gap within hours, and these mucosa cells are truly amazing. They can churn over and replicate faster than almost any other cell in your body. Also, the collagen underneath is laid down slowly in an organized pattern that looks just like the original tissue. Also, it’s a wet environment, and wet wounds heal faster than dry ones. That’s why now we often dress wounds with wet dressings to allow them to heal faster, because if they dry out, they heal slower.

[14:21 –> 14:44] Dr. Ravi Kumar: And then there’s the saliva, which we often think of as just watery secretions from our mouth. But that’s not what saliva is at all. Saliva carries growth factors that tell cells to divide and migrate. It carries enzymes like lysozyme that punch holes in bacterial cell walls, and it has antibodies. It is a healing fluid that the mouth’s covered in all day long.

[14:44 –> 15:04] Dr. Ravi Kumar: Dogs and humans both have all of that, but there’s a reason dogs’ mouths do so well with injury. Their saliva runs more alkaline than ours, which is a less friendly environment for a lot of bacteria that cause trouble and wounds. And a dog keeps the field moving as well. They lick, they eat, they drink. Nothing really stagnates back there in their mouths.

[15:05 –> 15:24] Dr. Ravi Kumar: And stagnation is what allows bacterial infections to take root. So that’s the anatomy of the dogs. That’s the biology of their oral mucosa and their saliva, and it helped Blue recover from his injuries. And some of these qualities we do have, but some of them we just can’t have. But that wasn’t all there was to Blue’s recovery.

[15:25 –> 15:57] Dr. Ravi Kumar: There was a psychological resilience, a grit that just amazed me. And that’s the part that’s been rattling around in my head for a couple weeks, Because the anatomy and physiology explains the resilience of his throat, but it doesn’t explain why dogs heal so fast everywhere else. I mean, think about it. A torn pad, a pulled muscle, a fracture, dogs come back from those things faster than we can do by a long shot. And the two things that explain it are the two things that we can actually mimic in our own lives.

[15:57 –> 16:13] Dr. Ravi Kumar: These are literal ways that we can be more like our resilient furry friends. And the first one is movement. So here’s what Blue did after his surgery. I brought him home in the middle of the night. He was still groggy from anesthesia, and he could barely walk in a straight line.

[16:14 –> 16:31] Dr. Ravi Kumar: And as soon as we got out of the car, he ran to hide behind one of his favorite trees, waiting for me to throw another stick. I’m not joking. He was just ready to go. And throughout the next week, if you didn’t know that he had torn his throat open, you wouldn’t have been able to tell.

[16:31 –> 16:39] Dr. Ravi Kumar: He was essentially acting like a normal dog. He played. He wagged his tail. He ate his soft food. He used his mouth.

[16:39 –> 16:54] Dr. Ravi Kumar: He didn’t guard it at all. He didn’t hold his head funny. He didn’t stop swallowing. He was basically unwilling to let the injury or the significant amounts of pain that I’m sure he was feeling affect him in any major way. Now think about what we do.

[16:54 –> 17:04] Dr. Ravi Kumar: Somebody hurts their back, and what’s the instinct? We lie down. We don’t move. We protect it. Somebody sprains an ankle, we wrap it and prop it up.

[17:04 –> 17:19] Dr. Ravi Kumar: Somebody breaks a wrist, we put it in a cast for six weeks. The whole culture of injury in medicine for most of the last century has been built on one idea. An injured part needs to be held still so it can heal. And I believed that. That’s just how I was trained.

[17:19 –> 17:37] Dr. Ravi Kumar: Early in my career, when a patient asked me after a spine surgery how long they should be resting, I’d tell them to take it easy for a few weeks. It just seemed like common sense. You don’t mess with something that’s healing. And it took me longer than I’d like to admit to realize what the tissue actually wants. So let’s take a look.

[17:37 –> 17:55] Dr. Ravi Kumar: Because for most tissues, it turns out that what they want is a healthy amount of load and stress to heal properly. Take cartilage. That’s like the smooth caps on the end of your bones inside a joint. Cartilage has very little blood supply. So how does it get nutrients?

[17:55 –> 18:13] Dr. Ravi Kumar: How does it stay alive? Well, it gets its nutrients by being squeezed. Every time you take a step, the cartilage in your knee compresses, and the fluid gets pushed out. And every time you lift your foot, it springs back, and fluid gets pulled in. And that fluid carries the nutrients that the cartilage needs.

[18:14 –> 18:36] Dr. Ravi Kumar: Cartilage is essentially a sponge that feeds by being wrung out and then refilled. If you hold the joint perfectly still for weeks, the sponge stops moving and the cartilage starves, and then it starts to thin. Immobilization doesn’t rest cartilage. It actually starves it. Now take muscle, and this is a brutal fact that most people have seen.

[18:37 –> 18:58] Dr. Ravi Kumar: When a limb is immobilized, muscle starts to atrophy within days. You can measure the loss within a week. By six weeks in a cast, a significant fraction of the muscle in that limb is simply completely atrophied. And that’s not a side effect of the injury, that’s actually a side effect of the treatment. Now, take tendons and ligaments.

[18:58 –> 19:24] Dr. Ravi Kumar: These are made of collagen, the same stuff as scar tissue. And the way collagen gets laid down depends on what the tissue is feeling while it heals. If there’s a gentle repeated pull along a tendon, the new collagen fibers line up along that pull like iron filings lining up in a magnetic field. That’s what makes a tendon strong. If there’s no pull, the fibers go down in a random tangle.

[19:25 –> 19:42] Dr. Ravi Kumar: Random directions weaken every direction, essentially. A tendon that heals in a cast heals worse than a tendon that heals under gentle motion. And that’s now a mainstream idea in hand surgery and sports medicine. And then there’s bone. Bone is the one that everybody thinks needs to be held still.

[19:42 –> 20:04] Dr. Ravi Kumar: And here’s where it gets interesting. There’s a principle in orthopedics called Wolff’s Law, and it says that bone reshapes itself according to the loads placed on it. Stress a bone, and it thickens along the lines of stress. Unload it, and it thins. Astronauts lose bone in space because there’s no gravity pulling them down onto the ground.

[20:05 –> 20:27] Dr. Ravi Kumar: And a healing fracture is no different. Gentle compression across a fracture line stimulates the cells to build that callus, which is the healing tissue of a broken bone. That’s actually the entire logic behind putting a plate or a rod into a broken bone. The hardware just holds the fragments in alignment so they can’t shift. And then the patient gets up and walks on it.

[20:28 –> 20:58] Dr. Ravi Kumar: The bone gets loaded, the muscle gets used, and the joints keep moving. And you skip the six weeks of wasting that you would get if you had casted the limb. Now, I don’t want anyone to hear this and then go cut off their cast. There’s a real window where rigid immobilization is the right call. An unstable fracture where the pieces will slide apart unless you immobilize it, or maybe a fresh tendon repair where the stitches can’t take any pull yet, or maybe even the first few days after some surgeries.

[20:58 –> 21:20] Dr. Ravi Kumar: In those cases, you need to listen to your doctor and protect the repair, full stop. The question is never movement or no movement. The actual question is, what does this specific tissue need to not fall apart? And can we protect just that and let everything else keep moving? So you wanna protect the fragments, but not the movement of the person.

[21:20 –> 21:40] Dr. Ravi Kumar: And that’s where the field has been going. In my own world, spine surgery, we used to keep people in bed after spine fusions. Now we get them up and walk them the same day, sometimes within hours after they wake up from surgery, because the outcomes are way better when people walk early. Hip fractures are the same thing. Get them up and let them walk.

[21:40 –> 22:08] Dr. Ravi Kumar: The risk of pneumonia and clots and deconditioning from lying down is still worse than any risk they would get from movement. Now here’s one thing that I think will surprise most of the parents listening. The most common fracture in a child is a buckle fracture of their wrist. So basically, the bone doesn’t snap, it just crumples on one side, kind of like a dented can. For decades, the treatment was a cast for a few weeks, sometimes with follow-up x-rays as well.

[22:08 –> 22:35] Dr. Ravi Kumar: Well, in 2022, The Lancet published a randomized controlled trial called FORCE, done across 23 hospitals in the UK with almost 1,000 kids. Half of those kids got a rigid cast or splint and then an x-ray follow-up, and the other half were offered a soft bandage and sent home. No cast, no follow-up x-rays. And the outcomes were essentially the same. The kids in the bandage group just got to be kids a few weeks earlier.

[22:35 –> 22:57] Dr. Ravi Kumar: That trial changed the national guidelines in the UK, and it’s still working its way through the US’s standard of care. Now I want you to think about a dog. How many times have you seen a dog just hauling butt through some town, holding one leg up, and running on the other three legs? They’ve broken their leg, maybe they’ve impaled the foot, who knows? But they’re not stopping.

[22:57 –> 23:13] Dr. Ravi Kumar: They’re not slowing down at all. And that movement is what helps them heal. And as soon as they can bear weight on that limb, they start bearing weight. Injuries to dogs don’t slow them down. Now, I’m not saying that you should be fully physically active without limitations after an injury.

[23:13 –> 23:30] Dr. Ravi Kumar: That’s not what I’m saying at all. But healthy, moderate movement is one of the keys to healing quickly from any injury. Now my dog Blue was hardly fazed by a massive injury. He wanted to run and play, and we instinctively held him back. But was that the right thing to do?

[23:30 –> 23:48] Dr. Ravi Kumar: It may not have been. So what does that mean for you practically? Well, if you’ve hurt something and it’s been looked at and it’s stable, the best thing for you to heal may be gentle use. So walk on a tweaked ankle. Maybe do easy range of motion on a hurt shoulder.

[23:48 –> 24:24] Dr. Ravi Kumar: Get out of the chair with a sore back. And when a doctor tells you to immobilize something, it’s completely fair to ask the question that I now ask my own self, and that’s what exactly are we protecting, and can we protect just that while letting the rest of the body move? One thing that I’ve recognized through my medical practice and my observation of ancestral practices and human biology is that movement is essential to life. As soon as you stop moving, you start dying. And when you need to heal, movement is one of the key factors that helps you heal faster.

[24:25 –> 24:54] Dr. Ravi Kumar: Movement is one of the keys to health, one of the keys to human health. And humans tend to pull back when they’re injured way more so than they need to. Dogs, well, maybe they push farther and harder than they should, but I think there’s a happy medium in between humans and dogs where we can realize the full potential of our healing process. Okay. So that brings us to the second thing we can change, the thing that’s really at the center of all of this, and that’s pain.

[24:54 –> 25:15] Dr. Ravi Kumar: Here’s what I noticed about Blue. In that first week after he tore his throat, he never whimpered once, not one time. He didn’t cry when he swallowed. He didn’t refuse food. The only tell, and I had to look hard for it, was that he panted a little more than usual for a couple days, and he took longer to settle in at night.

[25:15 –> 25:29] Dr. Ravi Kumar: That was it. Now part of that may be a deliberate act he was putting on. Dogs are descended from animals that were both hunters and hunted. And in that world, an animal that advertises its injury gets targeted. So dogs mask.

[25:29 –> 25:56] Dr. Ravi Kumar: They actually hide their pain. Blue certainly felt more than he showed, and the panting and the restlessness were the tells. Anybody who has a dog should know that subtle changes in posture, breathing, appetite, and sleep are how a dog tells you that he or she is hurt. But part of Blue’s behavior was real, and to understand which part, I need to split his pain into two concepts. The first concept is nociception, and that’s the raw pain signal.

[25:57 –> 26:23] Dr. Ravi Kumar: So a nerve ending in torn tissue will fire, send a signal up the spinal cord or up a cranial nerve until it reaches the brain. That’s the sensor, the pain signal coming from the nerves in the periphery. All animals, including humans, have it, and Blue’s pain sensors were surely firing all week long. The second concept is suffering, and that’s the psychological component. It’s what the brain does with the signal.

[26:23 –> 26:39] Dr. Ravi Kumar: It assigns meaning. It asks how bad is this and what does it mean? Is it gonna get worse? What will this do to my life? And the answer to those questions feeds back down and changes how loud that pain signal actually feels.

[26:40 –> 27:11] Dr. Ravi Kumar: The brain can turn up the volume, and the brain can turn down the volume. So the same nerves are firing, but there’s a completely different experience depending on the psychological story that’s wrapped around that nociceptive input. Human beings are spectacular at thinking too much about their pain. It’s the thing our big frontal lobes do best. We forecast, we anticipate, we narrate, and when it comes to pain, that machinery has a name, or that process of that machinery has a name.

[27:11 –> 27:39] Dr. Ravi Kumar: It’s called catastrophizing, and it means taking a sensation and attaching a future to it. So it’s not just my knees ache, but my knees ache, and that means the cartilage is going, and I’m gonna need a replacement, and I’ll never hike again. Every one of those thoughts turns the dial up on the raw pain signal that’s coming up from the periphery. And this phenomenon has actually been measured. People who catastrophize more report more pain from the same stimulus.

[27:40 –> 28:08] Dr. Ravi Kumar: They recover more slowly from surgery, and are more likely to end up with chronic pain. The dog doesn’t do that at all, not because they’re brave, but because they don’t have the brain machinery to catastrophize around a pain signal. So for instance, Blue had a sore throat, but he didn’t create a story about the sore throat. He had the signal without the suffering layer. And that’s a huge part of why he has so much resilience and so much grit.

[28:09 –> 28:36] Dr. Ravi Kumar: So the question I’ve been thinking about for the last two weeks is whether you and I can actually have that same type of pain response. Can a human essentially have the signal without the story? And the answer, it turns out, is partly yes, and there’s real evidence for it. The best trial I know of was run at the University of Colorado in Boulder. They took people with chronic low back pain, the kind where the MRI is basically normal and the pain has been there for years.

[28:37 –> 29:13] Dr. Ravi Kumar: There were 151 participants, and they gave one group a four week course of something called pain reprocessing therapy. So there were no injections, no drugs, no surgery. The entire treatment was teaching them to reinterpret their pain, to notice the sensation and deliberately stop attaching a forecast to it. At the end of four weeks, two thirds of the people who got the treatment were pain free or nearly pain free. And in the placebo group, or the patients who got just usual care without the pain reprocessing therapy, only about a fifth of them were better.

[29:14 –> 29:44] Dr. Ravi Kumar: And when they followed up a year later, most of that relief was still there in the treated patients. They also put people on a functional MRI scanner before and after, and they could see the brain change. The regions that assigned threat and emotional weight to a sensation were talking to each other differently after the treatment. Now that was chronic primary back pain in a particular kind of patient. It’s not a study of what to do when you tear your palate open with a stick, but the mechanism is the same mechanism.

[29:44 –> 30:03] Dr. Ravi Kumar: The suffering layer is trainable. You can teach a human brain to hear the signal and not write the story. And once you know that’s possible, it changes how you interpret every ache you’ve ever had. I did a full episode on exactly this with Dr. David Schechter a while back.

[30:03 –> 30:34] Dr. Ravi Kumar: He talked about the mind body approach to chronic pain, and it was a fantastic episode. I highly recommend you take a listen to that if you haven’t already. So that’s how we can interpret pain more like a dog, where we don’t attach meaning and catastrophization and a story to a nociceptive input, and it makes a big difference in how we react to pain. So I think that shows us how we may be able to be more resilient in the setting of pain just like our dogs. But I wanna leave you with a word of caution.

[30:34 –> 30:56] Dr. Ravi Kumar: Being more like your dog does not mean being less human. I don’t want you to stop communicating, stop being aware, stop paying attention. That’s the same machinery that makes you seek care early instead of hiding a problem until you’re septic. Dogs do hide problems until they’re septic. That’s the downside of masking, and it’s why so many of them come into the vet when it’s too late.

[30:56 –> 31:10] Dr. Ravi Kumar: You don’t wanna do that as a human being. What you actually want is the middle ground. When you hurt something, notice it, name it plainly, and don’t attach a forecast. For example, you might think there’s an ache in my knee. We’ll ask two questions.

[31:11 –> 31:21] Dr. Ravi Kumar: Is this stable, and can I move it? If it’s stable, move it, and do it gently and regularly. And don’t guard it if you can avoid it. You might need food. You might need water.

[31:21 –> 31:42] Dr. Ravi Kumar: You might need rest. And you might need medical attention. And this is an important point to make here. Remember, there’s no gold medal for not seeking proper attention to an injury. You need to take care of your body, but there are definite consequences to over assigning grief, suffering, and ruminating thoughts to pain in an injury that’s already been properly assessed.

[31:43 –> 32:06] Dr. Ravi Kumar: And I think that’s the point that I’m trying to make here. Okay. So let me sum up the whole episode right here. There are really two things that we can borrow from our furry friends, and these will help us be more resilient and have more grit and live generally better, healthier lives. The first is to understand that healing tissue wants to move and not rest excessively, except for a short list of serious injuries.

[32:07 –> 32:30] Dr. Ravi Kumar: So realize that movement is one of the keys to proper healing and long, healthy lives. And the second is to understand that pain has two layers, the signal and the story. And the story, which comes from our brains, is trainable. The dog has the signal without the story, and so can you, at least partly. And there are actual randomized controlled trials that prove this.

[32:30 –> 32:42] Dr. Ravi Kumar: Okay. So that’s it for today, folks. I hope you learned as much from Blue as I did. Blue is essentially two weeks out from his injury now, and at this point, he’s completely normal. You couldn’t even tell that anything ever happened.

[32:42 –> 33:02] Dr. Ravi Kumar: So I’ll see you next week. And in the meantime, please pass this episode on to someone you think might wanna hear it. Maybe it’s a dog lover. Maybe it’s someone who’s just interested in human biology or deals with chronic pain or maybe has a chronic injury that they’ve been trying to heal from. Those are all people who may benefit from this type of information.

[33:02 –> 33:20] Dr. Ravi Kumar: Also, check out my app, braingamer.app. It’s super fun, and it works the different domains of your brain without you ever feeling like you’re doing any work, and it’s free to play. It’s a great piece of software, and I’d really love to hear your feedback on it. Okay.

[33:20 –> 33:21] Dr. Ravi Kumar: Cheers, folks, and I’ll see you next time.

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