Back Talk Doc

What if back-pain relief was just a few steps away? Esther Gokhale’s work with posture and movement finds that just changing the way you sit, stand, lie down, and walk can eliminate your back pain. 

Esther grew up in India helping her mom treat orphaned babies and she studied biochemistry at college. Later, she became a licensed acupuncturist. So when her own pain and herniated disc issues emerged, it motivated Esther to study how people move. 

“There were some seeds already sown in my brain that ‘there's something going on with people who live close to the ground that makes sense and that works.’ And so when this horrible thing happened to me, it resonated for me to study techniques that changed the way you use your body,” Esther says.

Esther developed and trademarked the Gokhale Method, an eight-step plan to adjust your back’s curvature and movement from an S or C-shaped curve to a J-shaped curve. Esther found this technique by studying the common thread between ancient cultures and today’s primal cultures:

“If you go to your museums and you look at the Greek statues, they're doing exactly what these Ubong guys are doing, they look the same. And so why would that be? Well, the simplest explanation is that it is natural. That's why they converge on the same form. And we in modern times have just lost our way.”

In this episode, Dr. Lakhia and Esther talk through modern and ancestral movements, and what you can do right now to start moving more primally and, ultimately, relieve your back pain.

Read the Full Show Notes on our website BackTalkDoc.com. 

Name: Esther Gokhale

What she does: Esther used her crippling back pain during her first pregnancy to propel her interest in vanquishing back pain for all. Her Gokhale Method focuses on using posture and movement to bring the body back to a state of pain-free living. 

Company: Gokhale Method Institute, Inc.

Words of wisdom: “You often develop your passions in response to some humongous challenge that you're faced with. And if you manage to be successful in getting past that, you have acquired a lot of knowledge, skill, and insights.”

Connect: LinkedIn | Book 

👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode, Power of Compounding.

🔎 For more information on Dr. Sanjiv Lakhia and the podcast, visit BackTalkDoc.com.

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Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

Dr. David Schechter didn’t always buy into the idea of the mind-body pain connection. As a medical student, he relied on conventional and traditional approaches to pain management.

But that was before he developed knee pain that felt almost impossible to resolve. He tried mechanical therapy and strengthening exercises as is typically recommended, but nothing seemed to work. So he approached an NYU physiatrist for help: Dr. John Sarno, who became one of America’s most famous back pain doctors.

Dr. Sarno told Dr. Schechter that his pain was psychosomatic. “That really threw me for a loop,” Dr. Schechter said. “It was not what I was expecting to hear.” 

But it worked. And Dr. Sarno’s theory of Tension Myositis Syndrome, or TMS — that the mind creates pain in order to suppress traumatic events or subconscious thoughts and feelings — has been supported by independent research showing how the brain reacts differently to chronic and acute pain.

It’s an idea that has unfortunately come with social stigma: patients who suffer from TMS worry that the pain is “all in their head.”

But psychosomatic pain is real, Dr. Schechter says, and understanding how our brain impacts our physical bodies is the first step to accurate treatment and recovery.

Dr. Schechter joins us on episode 44 of Back Talk Doc to discuss the research behind mind-body medicine and the mind-body methods that best help address pain. 

“It's a more effective way to treat a particular type of symptom, typically chronic pain,” he says. “And it's a better way to define it. If you make the correct diagnosis, you're more likely to move forward with the correct treatment program.”

Read the Full Show Notes on our website BackTalkDoc.com.

Name: David Schechter, MD

What he does: Dr. David Schechter is a physician in Culver City, California with a medical degree from New York University. He specializes in sports medicine with a particular focus on non-surgical approaches and mind-body medicine. Dr. Schechter is the author of several books including The MindBody Workbook.

Company: David Schechter, MD (private practice)

Words of wisdom: “If you're afraid of failure, if you're afraid to not get there those opportunities may not ever become available. So don't be afraid to fail. Try it, and if it doesn't work out, learn from it and move on. And do even better next time.”

Connect: LinkedIn

👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode All About Radiofrequency Ablation for Spinal Arthritis with Dr. Stephanie Plummer.

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

🎧 Subscribe in your favorite podcast app. 

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

Bryana Gregory works at a compounding pharmacy, an option that many physicians in traditional medical circles have never considered.

But compounding could be the key to recovery and better long-term health for some patients. Rather than seeking only to relieve pain, compounding pharmacists take a holistic approach to a patient’s health to create personalized treatments.

“It’s like back in the day, when we used to have apothecaries, and see doctors and pharmacists behind the counter mixing up medications that were customized for the patient,” Bryana says. “Compounding pharmacy is more of an individualized approach.”

Often, treatments for pain involve as little medication as possible, with compounding pharmacists opting instead for supplements that can replenish or rebalance the entire body.

On this episode of Back Talk Doc, Dr. Lakhia talks with Bryana about what makes a good compounding pharmacist and how functional medicine can address pain.

We also talk about some popular treatments, including topicals like low-dose naltrexone, CBD, and even oxytocin, better known as “the love hormone.”

Read the Full Show Notes on our website BackTalkDoc.com.

Name: Bryana Gregory, PharmD, RPh

What she does: Bryana is a pharmacist and physician liaison who is passionate about compounding pharmacy and personalizing options for her clients to help them maximize their health. She majored in kinesiology at the University of California, Davis and later earned a PharmD at Harding University. In between, she competed as a professional golfer.

Company: Physicians Preference Pharmacy

Words of wisdom: “I think that the best thing that a patient or just anybody can do for themselves is to self-educate, to be your own advocate.”

Connect: Website | LinkedIn | Facebook

👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode CBD: Beyond the Hype with Matt Parks.

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

🎧 Subscribe in your favorite podcast app.

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com. 

Have you ever been told you have “Uncle Arthur,” more commonly known as arthritis? This ailment affects so many that either you or someone you know likely has pain from arthritis. With so many ways for a back to hurt, how do you tell if your back hurts from arthritis?

Back pain from arthritis is a somewhat different affair than disc pain or structural pain. Instead of the pain radiating, it stays fairly localized to the facet joints, which Dr. Lakhia refers to as “the knuckles of the spine.”

Back Talk Doc guest Dr. Stephanie Plummer walks through a specialized treatment that she performs called a radiofrequency ablation that is used to treat arthritic back pain. In short, the procedure “burns” the nerve that is causing pain, disrupting the signal from the nerve to the brain with few side effects.

To determine whether an ablation will be beneficial, patients go through not one, but two injection procedures called medial branch blocks. These are short-term anesthetic treatments to see if the targeted area gets relief from numbing various nerves. If both treatments are effective, the patient and doctor can decide whether radiofrequency ablation is right for them.

“Despite all the positives, patients should know that the results are not permanent. Over time, the nerves do repair and come back together,” says Dr. Plummer. If successful, patients can expect six months to two years of relief from radiofrequency ablation.

Ready the Full Show Notes on our website BackTalkDoc.com

Name: Stephanie Plummer, DO

What she does: While she’s a new partner at Carolina Neurosurgery and Spine, Dr. Plummer has been a practicing interventional spine physiatrist since 2013. Dr. Plummer completed her osteopathic medical school training at the Osteopathic School in New Jersey, served as a resident at East Carolina University and worked as a fellow in interventional spine through the Orthopaedic Specialists of the Carolinas in Winston-Salem, North Carolina.

Company: Carolina Neurosurgery and Spine

Words of wisdom: “My patients know that I talk a lot about core strength and core stability. I really think that that can't be underestimated and I don't know that any of us can ever be too strong in our core. I really try to make sure that I'm doing my job of keeping my core healthy by doing exercise for core strength and core stability a couple of times a week.”

Connect: Website

👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode A Breakthrough Treatment for Low Back Pain

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

🎧 Subscribe in your favorite podcast app.

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

Carolina Neurosurgery & Spine Associates’ Dr. Andrew Sumich is one of a handful of physiatrists across the country participating in trials of Relievant Medsystems' revolutionary technology that can reduce long-term pain for patients with chronic low back pain: the Intracept Spine Procedure.

The secret to the procedure lies in new research, which deepens the medical understanding of spinal anatomy. While most patients experiencing low back pain are treated for discogenic pain, recent findings have revealed that pain can actually originate from vertebral endplates, the bones found on either side of the disc.

Intracept targets the basivertebral nerve in a minimally invasive outpatient procedure, which improves function and decreases pain, even in the long term — a differentiating factor from many other low back pain treatment options.

Dr. Sumich has worked with approximately 40 patients in FDA-approved trials and has seen remarkable results firsthand, claiming that many procedures have resulted in “a home run” for pain relief.

He shares when the procedure is a viable option for those experiencing chronic lower back pain, when other treatment options may be a better fit, and discusses the profile of an ideal candidate for the revolutionary procedure.

Tune in to episode #41 of Back Talk Doc with Dr. Sumich to learn about the nitty-gritty of this medical procedure and how it’s transforming patients’ lives by reducing low back pain.

Name: Andrew Sumich, MD

What he does: Dr. Andrew Sumich is a member of the Carolina Neurosurgery & Spine team. He is a board certified physiatrist, specializing in interventional spine care.

Company: Carolina Neurosurgery & Spine Associates

Words of wisdom: “Where we put medicine matters in terms of what's hurting or not.”

Connect: LinkedIn

Top takeaways from this Back Talk Doc episode

★    There’s no one-size-fits-all for treating pain. There are many different causes for pain. Pain generation is an essential part of a medical diagnosis because it signals which treatment plans are most likely to benefit the patient. Not all pain indicates the same root cause, so while The Intracept Procedure may be a good fit for some candidates, it’s not a cure-all.

★    The Intracept Procedure targets vertebrogenic pain. Medical understanding of the spine continues to evolve. The role of endplates in the spine have just recently gained increased attention.

While most cases of chronic low back pain are treated as discogenic disorders, advanced and new understanding of the role of vertebral endplates has changed how to decrease pain for some patients. Vertebrogenic pain, unlike disc-oriented pain, is transmitted through the basivertebral nerve. The Intracept Procedure targets the nerve with a one-time ablation.

★ The results are “staggering.” Intracept’s parent company, Relievant Medsystems, has tracked results of the surgical procedure over a five-year period — a shockingly long time period for medical technology studies. The long-term efficacy of the procedure is unlike anything else that Dr. Sumich has seen in spine care. He’s also seen anecdotal evidence in the improved quality of life from the trial participants he’s treated.

[00:00] Check out our sponsor: QxMD builds mobile solutions that drive evidence-based medicine and clinical practice.

[01:42] Introducing Dr. Sumich: Dr. Andrew Sumich returns to the podcast to talk about a novel technique to treat low back pain: the Intracept Spinal Procedures. Dr. Sumich previously discussed spinal injections on one of our most downloaded episodes of Back Talk Doc.

[03:59] A breakthrough for back pain: The Intracept Procedure is a recent advancement in helping with neuropathic pain. Dr. Sumich shares the development of the procedure and how the field’s understanding of spinal anatomy has evolved.

[05:54] Pain generators, explained: There are many different things that can cause back pain.  Identifying which spinal structure is the biggest source of pain is essential to determining a treatment plan.

[9:15] Parts of the spine: The vertebral endplate is the anatomical focus for intracept spinal procedures. The understanding of endplate anatomy and how endplate health influences pain is a recent evolution in neuropathic medicine.

[10:13] Procedural options for back pain: Dr. Sumich provides an overview of treatment options for patients experiencing lower back pain (without pain that travels down the legs). Many patients have similar symptoms, but need different treatment plans.

[18:54] New knowledge creates new solutions: Medical breakthroughs in better understanding discogenic pain have allowed doctors to develop new treatments that better target root causes to pain.

[22:39] Durable pain relief: Unlike lumbar facet joint ablation, which needs to be repeated, intracept spinal procedures do not need to be repeated and results in long-term relief.

[24:17] Profile of an ideal patient: Dr. Sumich discusses FDA-approved indications that qualify potential patients for the new procedure.

[28:37] Insurance coverage for new technology: As is often the case, health insurance agencies are hesitant to cover new procedures. Parent company, Relievant Medsystems, can be a resource for individuals looking to pursue the procedure, but needing help coordinating insurance coverage.

[30:03] When a procedure hits a homerun: Dr. Sumich has helped approximately 40 patients at Carolina Neurosurgery & Spine Associates since 2020. He is pleased with the success rates and patient feedback.

[31:36] When a lumbar fusion is the better bet: Sometimes a lumbar fusion is a better solution to back pain. This depends on the patient’s level of instability. In some circumstances, a lumbar fusion is a better option, especially for those with narrowing foramen. Intracept spinal procedures are better suited for those in the early stages of disc degeneration.

[35:35] The upsides and downsides: Dr. Sumich shares the benefits of the new technology and outlines potential risk factors.

[39:43] Yoga as a health tool: Morning yoga has become a regular part of Dr. Sumich’s well-being regimen during the pandemic. A personal favorite is “5 Sun Salutation As +Bs” on YouTube.

👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode These Simple Exercises Will Keep Your Back Healthy With Jackson Bellis, DPT.

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

🎧 Subscribe in your favorite podcast app.

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

As a CrossFit level 1 trainer with a 13-year physical therapy career and an interest in golf, running, skiing, and hiking, it’s fair to say that Dr. Jackson Bellis practices what he preaches when it comes to maintaining a healthy back.

Dr. Bellis is always challenging his own body and encouraging his patients to safely challenge their bodies to see what they can do.

“I really think we can make a big change in back health. And I think looking at the way we move, and the things that work and don't work, is a big piece of it,” he says.

Back health has everything to do with the way we move. Some of the most frequent patients who come into our offices are runners, golfers, and truck drivers.

And while their pain might have different causes, it all really comes down to movement, and a few go-to exercises can help almost any type of pain, Dr. Bellis tells us. It’s all about the hips, the abs, and the glutes.

Dr. Bellis shares actionable advice for how stretching and strength-training can serve as strategies to maintain and improve mobility.

Tune in to episode #40 of Back Talk Doc with Dr. Bellis to learn more about the tactics we should all be doing to help treat — and prevent — pain.

Name: Jackson Bellis, DPT COMT

What he does: Dr. Bellis has been a physical therapist for 13 years, spending 10 of those years of service at Carolina Neurosurgery. He is also a certified orthopedic manual therapist (COMT) with experience in dry needling, selective functional movement assessment (SFMA), and titleist assessment. He enjoys CrossFit, running, golf, skiing, and hiking.

Company: Carolina Neurosurgery & Spine Associates

Words of wisdom: “One thing my patients always say is, I did not realize how tight I was. I did not realize how weak I was. If we never really get to the point where we're trying to see what our body can and can't do, we may not be enjoying it to the fullest.”

Connect: LinkedIn ⼁Website

Top takeaways from this Back Talk Doc episode 

★    Think backwards. When trying to figure out the source of pain and how to treat it, it can help to think backwards and treat with opposite movements. For example, if someone has pain from bending forward, laying down in an extended position can help take pressure off the nerve. Treatment can be active, “like on the ground in a cobra position” or passive. “It’s a way to test out and find out Hey, this was a disc."

★    It’s all in the hips. “Everything in life is through the hips,” Dr. Bellis tells us. Understanding how the hips work can also help us understand what causes pain, and figure out the right treatments. Learning how to properly bend at the hips and use the hips during exercise can keep your back healthy and prevent injury. How to use your hips to bend (VIDEO)

★    The bridge and plank are key to a healthy back. Whether it’s lower back pain, seated pain, walking pain, or pain from bending over, Dr. Bellis swears by these two exercises that activate the glutes and the abdominals. Doing it correctly can help control the neutral position of the spine. “I have never had a person come in here with back pain who could activate their abdominals and activate their glutes,” he says.

[00:00] Check out our sponsor: QxMD builds mobile solutions that drive evidence-based medicine and clinical practice.

[01:38] Introducing Jackson: Today’s guest is our very own Jackson Bellis, a physical therapist and manager at Carolina Neurosurgery’s Matthews office who has been with us for 10 years.

[03:12] Flexion-sensitive disc pain: We open our Q&A with Dr. Bellis with a common condition that can lead to a herniated disc: radiculopathy, or the type of back pain that comes from bending over.

[06:10] Restoring confidence: Figuring out what went wrong in the first place is step one in physical therapy for patients with herniated discs, and the first step toward building the confidence to bend again. All that power, Dr. Bellis says, comes from the hips.

[7:34] How to hinge: Dr. Bellis discusses common hip faults and how to properly use our hips to bend.

[8:44] Think opposites: One tactic that can help identify a disc herniation and reduce pain is working in opposites: extending the body in the opposite direction in which the pain occurred, making sure to work slowly and gently. Dr. Bellis gives us some at-home tips.

[12:01] Staying on the course: With constant twisting and rotating, golfing may be one of the hardest activities on your back. Dr. Bellis tells us how using the hips and upper back can keep golfers healthy. Back Talk Doc discusses golf rehabilitation in-depth in a prior episode with Dr. Graham Claytor.

[13:46] Standing pain: The causes of lower back pain when standing or walking usually comes from spending too much time in a hyperextended position. Treatment differs from patient to patient. We discussed spinal stenosis with Joe Cheadle on episode 16 of Back Talk Doc.

[18:37] Sitting pain: Carolina Neurosurgery often sees truck drivers coming in with increased back pain. Sources and treatment of that pain can differ, from pelvis imbalance to a disc issue.

[23:10] SI joint pain (or Sacroiliac Joint Dysfunction): Treatments as simple as daily leg extensions can help relieve sacroiliac joint pain, the pain from the joints where the hip bones and the sacrum meet.

[27:24] Keep the glutes active: Dr. Bellis shares his go-to glute exercises and explains how they can help the back, from relieving SI joint pain to strain from golfing.

[29:54] Essential exercises: Dr. Bellis recommends two exercises for anyone and everyone, with or without pain: the bridge and the plank. These exercises can lead to greater control of the spine. “Like we talked about, where does the power come from? Power comes from the hips.”

[32:51] The great hamstring debate: Is stretching our hamstrings really necessary? It depends on who you are and the type of activity you do every day. “When I'm meeting my average person to learn how to bend over [to load] the dishwasher, I can get that person to learn how to hip hinge pain-free without necessarily having to stretch their hamstrings.”

[35:58] Words of wisdom: Dr. Bellis shares his advice on challenging your body and paying attention to previous injuries.

👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode Fact or Fiction: the Truth About Lumbar Spinal Injections.

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

🎧 Subscribe in your favorite podcast app.

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

Lumbar spinal injections can help reduce back and leg pain and are a highly requested treatment at our offices.

But there are also plenty of misconceptions about them.

Can epidurals be a first-line treatment for low back pain? How well can they help us determine a source of pain? Can injections heal discs?

We brought on Dr. Joseph Zuhosky, who recently joined our team at Carolina Neurosurgery & Spine Associates, to get answers to these questions and more. Along the way, we hope to alleviate some myths and points of confusion about spinal injections.

Joe gives us his recommendations for when – and how – to treat pain with epidurals, explaining how they can not only help treat pain, but also help narrow down a pain’s source and identify further treatment.

“​​I think there definitely is a role for epidural steroid injections in identifying pain generators. And if it doesn't give our patient long-term, effective relief that they can live with, it helps our surgical partners to determine that it is, indeed, a level that we can reliably operate on.”

Toward the end of this episode, we also hear more about Joe’s personal experiences with disc herniations and how he’s been able to recommend exercises based on his own experience with the workout group he co-founded.

Name: Joseph P. Zuhosky, MD

What he does: Before joining us recently as a physician at Carolina Neurosurgery & Spine Associates, Dr. Zuhosky went to medical school at The Ohio State University. He did his residency at the Rehabilitation Institute of Chicago at Northwestern University McGaw Medical Center and completed a fellowship, training in sports and spine rehab, at the Illinois SPINE & Sportscare Centers, Ltd. in Bloomingdale, Illinois.

Company: Carolina Neurosurgery & Spine Associates

Words of wisdom: “I don't think we should take all the credit for healing the disc … it's a thought of managing it going forward because even when the pain isn't there, you still have a weak area of your body that you're going to have to compensate for going forward.”

Connect: Website

Top takeaways from this Back Talk Doc episode

★    Injections are more than just a band-aid. Some patients worry that getting a spinal injection will only be a temporary fix for their pain. But it actually does a lot more than that, as long as the injections are used appropriately. While pain relief may only be temporary, an injection can tell us more about where the pain comes from and gives us clues on further ways to treat the patient.

★    A ‘series of three’ injections can limit treatment options. The ‘series of three’ injections myth stems from a research study on sciatica originally published in 1960, but further research found this treatment is only effective two times out of three. Since doctors can only give a limited number of injections within a period of time, this method can also rule out other treatment options that offer quicker relief.

★ An epidural is only one part of treatment. While a shot can relieve pain, it can’t actually heal a damaged disc. Instead, the epidural steroid reduces the swelling and inflammation that causes pain, getting the patient through the acute stage while Mother Nature does the rest of the work.

[00:00] Check out our sponsor: QxMD builds mobile solutions that drive evidence-based medicine and clinical practice.

[01:59] Meet Dr. Joe: Joseph Zuhosky is the newest member of Carolina Neurosurgery & Spine Associates. Before joining us, he did his residency at the Rehab Institute of Chicago at Northwestern University and a fellowship in sports and spine rehab in Bloomingdale, Illinois.

[04:05] From pediatrics to orthopedics: Dr. Zuhosky talks about his varied interests as a medical student, beginning in pediatrics and eventually landing in spine health.

[06:32] Fact or fiction: Lumbar spinal injections are a type of corticosteroid that can reduce inflammation and alleviate back pain in the back and leg. We clarify some misconceptions about the injections.

[07:33] Low back pain: Though a lot of patients seek lumbar spinal injections for low back pain, epidurals generally have a low success rate among this population.

[10:59] Specificity: An injection can be helpful in determining a source of pain and ways to treat it, as long as the injection is done appropriately.

[15:02] Series of three: Originally introduced in a 1960 paper, the ‘series of three’ injection treatment strategy is a myth: Since the number of injections that can be given to a patient is limited, this practice could limit further treatment options.

[18:49] Discs: The steroid injection does not necessarily “heal” a disc, but it does reduce the inflammation and pain caused by a herniated disc and can help patients through the acute healing phase.

[22:18] Spinal stenosis: There are advantages to using lumbar epidural injections to treat spinal stenosis, but to suggest that they can heal this condition is misleading. Spinal stenosis was discussed on a previous episode with Dr. Joe Cheatle.

[26:38] Center or side: A transforaminal epidural – or when the epidural is injected directly to the nerve root rather than off-center – tends to have a slightly higher response rate.

[34:22] Personal experience: Dr. Zuhosky has personally experienced both lumbar and cervical hernias. He recommends a workout group with branches across the country called F3 that has helped with his lower back pain.

[40:15] Hamstring exercises: Dr. Zuhosky tells us more about hamstring stretches that won’t aggravate the back.

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🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

🎧 Subscribe in your favorite podcast app.

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

Health care has been a constant presence in Matt Parks’s life for much longer than most people.

His mother is an ER nurse. His older brother was born with a rare condition and was often hospitalized as a child. And as a college baseball player, Matt started taking nonsteroidal anti-inflammatory drugs (NSAIDs) to cope with a shoulder injury.

He became dependent on the medications and started to experience migraines. He also developed depression when his parents divorced, which he still struggles with.

By 2019, having been Vice President and Sales Manager at Williams Medical Supply Inc. for over a decade, Matt was a veteran of the medical supply industry. Conversations with people in his field who had looked into cannabidiol — better known as CBD — and customers who had used it, convinced him that the majority of CBD products were ineffective.

This inspired him to see if he could come up with something better. He had three main areas of improvement. He wanted to create a hemp-derived topical CBD cream that he could verify did not contain tetrahydrocannabinol (THC), the main psychoactive compound in cannabis. He also wanted to build a company that was directly accessible to customers who had questions, and a brand that didn’t traffic in the usual hype.

That year, he founded One Less CBD — as in “one less pill to take.”

Listen to this episode of Back Talk Doc to find out what CBD is and isn’t, how to choose a CBD product, and to hear about Matt’s journey from patient to employee to entrepreneur.

Name: Matt Parks

What he does: Before founding One Less CBD in 2019 and leading the business as CEO, Matt was Vice President and Sales Manager at Williams Medical Supply Inc for over a decade.

Company: One Less CBD

Words of wisdom: “[CBD is] not going to regrow cartilage. What we see is a daily topical application to help people become more mobile, become more active and create a better overall lifestyle, and stop reaching for two or three Aleve every single day, and apply something that is more plant-derived and natural.”

Connect: LinkedIn

Top takeaways from this Back Talk Doc episode

★    CBD is thought to help reduce inflammation by assisting your body’s endocannabinoid system (ECS). Endocannabinoids are anti-inflammatory molecules produced by your body. However, certain enzymes interrupt the ECS process, and absorb endocannabinoids, reducing the system’s effectiveness. “The whole idea behind CBD is, let's introduce more cannabinoids, block out some of those enzymes, and actually let the body do some natural healing,” Matt says.

★    Hemp-derived and marijuana-derived CBD are different. Both hemp and marijuana are types of cannabis plants. The key legal difference is that marijuana contains more than 0.3% THC, the psychoactive component that causes users to experience a high, and less CBD than hemp. Hemp contains 0.3% THC or less. It’s important that CBD consumers know that the topical they’re using does not contain more than 0.3% THC, because if it does, they could fail a drug test.

★    Consider who’s selling you CBD. If you have a question about the CBD you just bought, it’s not a given that you’ll be able to connect with a real person or even find legitimate information on the product’s website. And while CBD is legal, there’s no regulatory body for the industry yet. Get it from a naturopath or chiropractor rather than, say, a gas station or convenience store.

Top takeaways from this Back Talk Doc episode

[00:00] Mobile-based solutions for clinical practice: Check out our sponsor, QxMD, which builds mobile solutions that drive evidence-based medicine in clinical practice.

[01:44] Meet Matt: Matt Parks is the founder and CEO of One Less CBD. As a college baseball player, Matt injured his shoulder, and began taking NSAIDs to cope. He became dependent on the medications, which led to migraines.

[6:04] Unimpressed: Working in the medical supply industry after college, Matt interacted regularly with consumers dealing with painful conditions like rheumatoid arthritis. They were underwhelmed by CBD products. Matt was inspired him to come up with a superior product.

[10:34] Opening the floodgates: The 2018 Farm Bill took CBD off the Schedule I narcotics list, which sparked the CBD craze. But there wasn’t any regulatory framework to ensure quality control.

[16:29] Blocking the blockers: The endocannabinoid system (ECS) reduces inflammation in our bodies by releasing cannabinoids, but these cannabinoids are sometimes intercepted by enzymes that absorb enough of them to prevent the ECS’s therapeutic effects. CBD products are designed to block some of these enzymes so healing can occur.

[18:30] A supplement, not a cureall: Matt describes his CBD as a topical application to help people become more active and mobile, while avoiding the stomach damage that can result from taking NSAIDs like ibuprofen or aspirin. The name One Less CBD refers to taking one less pill. 

[22:08] The goal: Everything One Less sources is made in the U.S. Matt and his team found a supplier who could provide them with 99.99% pure CBD. It was important that there was no THC in their product, so that customers would not experience side effects or fail drug screenings.

[28:06] Full disclosure: A transparent CBD company should provide contact information, indicate whether its products have been tested by an independent third-party, and list where its CBD is available for purchase.

[33:54] The future of CBD: CBD is still trending upward despite a decline during COVID-19 — and Matt predicts that it hasn’t peaked yet.

[36:01] Worth a look: Matt recommends the Original Strength fitness program and the book “Atomic Habits” by James Clear.

[39:34] Special offer: Get a free travel jar of One Less CBD Topical Inflammation Cream. Just pay $4.95 for shipping.

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👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode A Neurological Approach to Treating Pain.

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com. 

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Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

Being told your pain is only in your head is maddening when it’s your back that hurts. But is there more truth to this statement than we have long believed?

NeuFit founder Garrett Salpeter says that pain is sometimes not an accurate depiction of the extent of an injury, but rather an overreaction by your nervous system.

At NeuFit, Garrett draws on his background in engineering and neuroscience to help athletes and other patients recover from injury, develop sustainable fitness regimens, and improve their overall health.

Garrett joins this episode of Back Talk Doc to explain why his unusual approach to treatment acknowledges the structural focus of traditional pain management, but operates within a neurological framework.

“There is this very important common thread… from early-stage rehabilitation all the way through general fitness and elite athletic performance, and that is the nervous system,” Garrett says. “It controls so many things about us: How we heal and recover from injuries, how our muscles work and move, whether we experience pain or not.”

Garrett also created a new muscle stimulation device, the Neubie, that combines the alternating current traditionally used in these devices with direct current, to maximize relief. In addition to using it with patients, he relies on it to optimize his own workouts.

Listen to this episode of Back Talk Doc to explore the intersection of neuroscience, engineering and physiology, and how it can offer a holistic approach to treating pain.

Name: Garrett Salpeter

What he does: Garrett has studied engineering and neuroscience. From this unique vantage point, he leads neuromuscular therapy provider NeuFit, which is dedicated to treating athletes and patients, helping them reach their fitness goals and heal from injuries. He also hosts The NeuFit Undercurrent Podcast and is the author of “The NeuFit Method: Unleash the Power of the Nervous System for Faster Healing and Optimal Performance.”

Company: NeuFit

Words of wisdom: “If someone comes in because they ‘threw out their back’ …  in that really acute spasm-like state, a lot of times there’s some minor insult or something like that, but the reason that they’re in such pain and they’re so debilitated is because of the neurological overreaction.”

Connect: LinkedIn

Top takeaways from this Back Talk Doc episode

★    Examining your pain within a neurological framework offers advantages over a traditional approach. The traditional approach to treating pain tends to lean heavily on structural explanations: If your back hurts, there must be something physically wrong with it. Instead, focusing on your body’s response to an insult as a neurological overreaction that creates pain (without discounting the possibility of a structural issue) may be more effective.

★    The body’s protective responses to stimuli are necessary, but often an overcorrection. When Garrett and his team identify a defensive neurological reaction to an insult, they are careful not to eliminate it completely, because it serves a purpose.  Yet the response is often too far-reaching. Many times, this has to do with bad habits that a patient has developed in the way they move their bodies, so treatment is usually more a matter of recalibrating the response than getting rid of it.

★    When it comes to muscle stimulation, direct current is worth a second look. Direct current fell out of favor among pain specialists decades ago. Despite its therapeutic effectiveness, it burned and stung the skin. To address this and harness direct current’s power, Garrett developed the Neubie, a device whose proprietary waveform feature uses alternating and direct current.

Top takeaways from this Back Talk Doc episode

[00:00] Mobile-based solutions for clinical practice: Check out our sponsor, QxMD, which builds mobile solutions that drive evidence-based medicine in clinical practice.

[02:01] Meet Garrett: Garrett Salpeter is the author of “The NeuFit Method: Unleash the Power of the Nervous System for Faster Healing and Optimal Performance.” He founded neuromuscular therapy provider NeuFit, and also hosts The NeuFit Undercurrent Podcast.

[04:59] The common thread:  From general rehab patients to elite athletes, the nervous system is the key differentiator when it comes to controlling how we recover, move, think and feel. It controls our muscles, hormones and pain responses.

[6:10] Tip of the iceberg: Often when a patient comes in complaining of an acute injury, the real reason for their pain, even if they have suffered some minor injury, is the nervous system’s overreaction to it, e.g. a back spasm.

[6:59] A different paradigm:  Instead of focusing on the affected structures, Garrett and his team focus on the neurological responses to injuries. They do this by identifying where the brain and nervous system are activating those responses, and stimulating those areas to reset, recalibrate and reeducate the response patterns.

[9:02] First things first: This is a different framework but not a substitute for considering real physiological issues. Before investigating a patient’s neurological responses, NeuFit checks to make sure there’s nothing structurally wrong with them.

[11:32] Root causes: When patients experience pain from certain types of movements or extensions, it’s often because certain muscles are shut down or inhibited.

[13:01] The strength within: By measuring and mapping pain and then focusing on root causes, NeuFit helps people tap into muscle they already have but are preventing themselves from activating.

[13:57] Hyperfocus: In addition to manual muscle testing, NeuFit uses electrodes that send direct currents to identify the protective responses the patient is exhibiting.

[18:49] Next-level muscle stimulation: NeuFit’s proprietary device, the Neubie, uses direct current stimulation to communicate with the nervous system precisely and efficiently, and alternating current to provide comfort during muscle stimulation.

[25:37] Balancing it out: NeuFit’s treatment process determines how much of the body’s neurological response is necessary, and how much is an overreaction to a perceived danger. 

[27:54] More function than form: Garrett has seen people make more progress by emphasizing function over structure.

[31:05] Sweeter dreams: Using the Neubie in conjunction with his workout regimen, Garrett has significantly improved his quality of sleep.

[37:08]  What he’s reading: Garrett recommends “Head Strong” and “Super Human” by Dave Asprey.

Ready to boost your energy and reduce inflammation all day long? Download the Morning Routine Dr. Lakhia uses to begin each day.

👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode The Art and Science of Trigger Point Treatments.

For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

Subscribe in your favorite podcast app.

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

Sometimes imaging doesn’t explain a patient’s pain, and when that is the case, many will feel discouraged if not flat-out alarmed.

Trigger points can offer answers, and it’s the topic of this episode of Back Talk Doc.

Marty Kestin joins the podcast to explain more about trigger points and how they are involved in causing pain. At Ensoma Bodyworks, Marty teaches both patients and students how to restore and improve body functioning by the way of advanced orthopedics like neuromuscular massage therapy and neuroplasticity.

Trigger points typically come into play when MRI imaging and other avenues of identifying pain come up short. Just because the cause of pain can’t be detected through imaging, doesn’t mean the patient is faking it. Quite the opposite. As Dr. Lakhia remarks in this episode: “Your pain is real. We're going to go on the hunt to find where it's coming from.”

Listen to this episode of Back Talk Doc to understand the science behind how trigger points work, their role in causing pain, and how understanding them can lead to better pain management. 

Name: Marty Kestin

What he does: As a Pain Detective, Marty draws on 25-years of pain management experience to not only find what is causing a patient’s pain, but to rid them of it.

Company: Ensoma Bodyworks

Words of wisdom: “My practice has been attracting recalcitrant or just stubborn enigmatic cases for about 10, 15 years now. Fortunately, they've already been to the doctor, or the chiropractor, or the PT, or the acupuncturist. Or the massage therapist. They come to me and go, ‘Nobody could figure it out.’ So they've gone through a lot of diagnostics and assessments, and I ask them, ‘How many people have examined your skeletal muscle in a microscopic way where they're combing over what they think the problematic area could be?’ Almost always, nobody's ever done that for them.”

Connect: LinkedIn

Top takeaways from this Back Talk Doc episode

★    Don’t overlook trigger point evaluation if you haven’t come up with answers for your pain.  Many doctors don’t consider trigger points when it comes to determining the cause of pain; you’ll need to see a specialist. It’s important to know that it is an option, especially if a physician cannot determine what is causing your body pain in a traditional manner.

★    There are multiple ways to treat trigger points. There is never a one size fits all approach to pain, even when the pain results from trigger points. With a host of different treatment options, it’s important to understand each treatment method and what may be best for you. Dry needling is particularly popular, but “spray and stretch” may be more comfortable for some people.

★    Other symptoms could be related to trigger points. With trigger points, it’s not uncommon for there to be other symptoms aside from pain. Abdominal trigger points can cause diarrhea or IBS, for example.

[00:00] Mobile-based solutions for clinical practice: Check out our sponsor, QxMD, which builds mobile solutions that drive evidence-based medicine in clinical practice with over 500 easy-to-use decision support tools.

[01:50] The bodywork savant: Dr. Lakhia introduces Marty, a friend and colleague, and his work with trigger points and massage therapy.

[03:43] What is a trigger point?: Marty defines exactly what a trigger point is by explaining its history and physical representation in a person’s body.

[08:21] When to suspect a trigger point: Dr. Lakhia asks Marty what can indicate a trigger point is the cause of pain and what to look out for, and which doctors to seek out.

[11:09] A short history on imaging studies: Marty talks about imaging studies — especially in relation to trigger points and pain patterns.

[13:18] Treatment options: Dr. Lahkia brings up different options for treatment of trigger points from Travell’s method to injecting trigger points with substance. Marty offers additional suggestions, including self-treatment options.

[17:10] Classic pain patterns: With trigger points, there are classic pain patterns to know and understand, like sciatica. Dr. Lakhia and Marty explain what the most common pain patterns are and how to identify them.

[21:26] When a headache isn’t just a headache: Trigger points can, well, trigger autonomic symptoms such as headaches, vertigo, and dizziness. Marty discusses the autonomic presentations that he has seen.

[24:42] It’s not just about the back: The front of the body and its trigger points often get neglected in favor of back and spinal issues.

[26:52] Self-care in the modern age: Marty offers suggestions for how people can stay out of trouble when it comes to trigger points.

[28:42] How Marty thrives personally and professionally: Marty breaks down what keeps him going, not only as a clinician but as a human being.

👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode Should You Be Concerned About Seeing a Physician Assistant for Spine Care?

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

🎧 Subscribe in your favorite podcast app.

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.