Back Talk Doc

From Kim Kardashian getting a vampire facial to Hines Ward's extraordinary knee recovery in the weeks leading up to the 2009 Super Bowl, regenerative medicine has gained a tremendous amount of interest in both the lay population and the scientific community. This medical-assisted self-healing process has helped athletes including Tiger Woods, Kobe Bryant and other high-profile celebrities not only overcome injuries but increase their recovery times.

On this special one-year anniversary episode of Back Talk Doc, Dr. Lakhia welcomes Dr. John Lesher to discuss regenerative spine and orthopedic medicine, including the use of platelet-rich plasma (PRP) injections and stem-cell therapy. Dr. Lesher is board certified in physical medicine and rehabilitation with subspecialty certifications in sports medicine, electrodiagnostic medicine, and certification in musculoskeletal ultrasound.

Dr. Lesher shares his experience and knowledge in regenerative spine and orthopedic medicine from a personal and professional perspective. Given his background in athletics, he also discusses regenerative medicine and its applications in the sports arena.

• What we mean when we say “regenerative medicine” (8:32)
• Examples of medical-assisted self-healing (9:47)
• Stem Cells 101 (14:01)
• Joint arthritis: the difference between corticosteroid injections vs stem cells or PRP (20:22)
• Effectiveness of regenerative medicine options: joints and tendons (23:34)
• The role for regenerative medicine in spine care (32:45)
• The future of regenerative medicine (43:26)
•  Dr. John Lesher’s personal health tips (46:19)
• Dr. John Lesher’s podcast recommendations (48:03)

• Prospective study of disc repair with allogeneic chondrocytes presented at the 2012 Joint Spine Section Meeting by Coric D, Pettine K, Sumich A,
• Mesoblast Study by Mesoblast the regenerative medicine company
•  Cell-based therapy for spinal disc regeneration by Coric D.
• Clinical Study to Evaluate the Safety and Preliminary Efficacy of IDCT, a Cell Therapy to Treat Moderate, Symptomatic Lumbar Degenerative Disc Disease by Silverman L, Coric D, Foley K,
• British Journal of Sports Medicine
• Outside podcast
• The Peter Attia Drive Podcast
•  The People's Pharmacy

For more information on Dr. Sanjiv Lakhia’s practice, visit BackTalkDoc.com

If you enjoyed this episode of Back Talk Doc, check out our episode Introduction to Spinal Artificial Disc Replacement Surgery with Dr. Dom Coric.

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 atcarolinaneurosurgery.com.

In the world of back pain, there are a variety of vendors in the marketplace offering purported solutions. And, with patients searching for alternatives to injections, physical therapy, surgery, and traditionally prescribed medications, the market for these alternatives treatments is booming. With these solutions ranging in efficacy from widely accepted remedies to ineffective and potentially harmful, how do you know what is and isn’t safe? Welcome to Back Talk Doc.

In this episode, Dr. Sanjiv Lakhia is taking on gravity-assisted devices, more commonly known as inversion tables. Dr. Lakhia reveals his personal experience and research with inversion tables and addresses the most common questions he receives from patients: “When I tilt on [the inversion table], it helps. But, is that safe? Is this something that's effective? Something that I should use?"

Dr. Lakhia presents two studies on inversion therapy, explaining the methodology of the studies, and the conclusions presented. Dr. Lakhia then provides examples of how to perform common gravity-assisted interventions for low back pain.

·     Inversion Therapy in Patients with Pure Single-Level Lumbar Discogenic Disease: A Pilot Randomized Trial (02:16)

·     What is an inversion table? (04:14)

·     Lumbar decompression (5:08)

·     Warnings about using gravity-assisted devices (9:47)

·     The Effects of Aquatic Exercise Programs on Low Back Pain Disability in Obese women. (11:17)

·     Summary of the two research articles (16:56)

·     Inversion Therapy in Patients with Pure Single-Level Lumbar Discogenic Disease: A Pilot Randomized Trial by Prasad KS, Gregson BA, Hargreaves G, Byrnes T, Winburn P, Mendelow AD.

·     The Effect of Aquatic Exercise Program on Low Back Pain Disability in Obese women. by Abadi, F. H., Sankaravel, M., Zainuddin, F. F., Elumalai, G., & Razli, A. I.

For more information on Dr. Sanjiv Lakhia’s practice, visit backtalk.com

If you enjoyed this episode of Back Talk Doc, check out our episode Worth a Shot? Spinal Injections with Dr. Andrew Sumich.

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.

If you live or work in the Carolinas, you probably either play golf or have a friend or loved one that plays. Golf is an excellent sport for children and retirees alike and a popular activity for competitive exercisers that don’t want to strain their bones and muscles in high-impact sports. However, golf can also lead to its fair share of aches and pains, so today’s episode focuses on preventing and treating golf-related injuries.

On this episode of Back Talk Doc, our host Dr. Sanjiv Lakhia welcomes Dr. Graham Claytor, Director of the Physical Therapy at Carolina Neurosurgery & Spine Associates, to explore his golf rehabilitation and fitness programs. While Dr. Claytor admits physical therapy wasn’t a childhood dream, a combination of family and educational experiences ignited his passion for patient work.

After several years in private practice, Dr. Claytor met professional golf agent Thomas Parker, catapulting him into his niche in golf rehabilitation and therapy, “look, I have a lot of guys that need this kind of specific golf treatment and there’s not really anybody around here that’s doing this. There are places in Florida, whether it’s a golf mecca, there are places in California, but there’s not really this niche in Charlotte.” (7:28)

Dr. Claytor explores his TPI certified program, The Golf Rehabilitation and Fitness Program, his typical patients, and a number of recommended exercises. He also reveals the preventative benefits of the golf rehab program and available recovery resources for patients, “any of Greg Cook’s stuff is very good. And any of the Sea Island golf pro guys that are trainers down there, Randy Myers, some of the golf fit pro apps are very good to go see. (31:28)

To learn more about Dr. Graham Claytor’s Golf Rehabilitation and Fitness Program, visit GolfRehabAndFitness.com. For more information on Dr. Sanjiv Lakhia and treatment options for back issues, visit backtalkdoc.com

If you enjoyed this episode with Dr. Graham Claytor, check out our episode on Health Care and Spirituality, with Dr. John Welshofer.

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

Imagine you suffer from a painful disc injury that prevents you from engaging in many of your daily activities. For most people, the obvious course of action is to go see your doctor, where it’s likely you’ll have a physical examination and be prescribed medications and/or surgery. At the end of this course of treatment, you hope to be pain-free and back to your daily routine. Many patients never stop to ask themselves, “is there anything else I could be doing to improve my circumstances?” Dr. John Welshofer would answer you with an emphatic “yes!,” and he’s here today to tell you why.

While the idea of spirituality can be off-putting for some, a growing number of physicians believe spirituality can play a significant role in our physical and emotional health. On this episode of Back Talk Doc, our host, Sanjiv Lakhia, speaks with Dr. John Welshofer, a physician that believes in integrating faith and spirituality into the healing process. Always a science-minded person, Dr. Welshofer became interested in medicine after a severe car accident left a close friend paralyzed from the waist down. (2:17) After his residency in physical medicine and rehabilitation, he regularly dedicated his time to medical mission trips, where he served in communities that lacked health care.

Wanting to give back and serve others, Dr. John Welshofer traveled with the Bless Back Worldwide organization to Haiti and Nicaragua to provide care for underserved communities. For Dr. Welshofer, this experience gave him perspective on how fortunate he was to live in the United States. “[I]t makes you very appreciative of what you have, but also sort of stokes the fires of trying to help others beyond just your own comfort zone.” (6:05) While Dr. Welshofer encountered some truly devastating cases, the positive metamorphosis he observed over the course of return trips showed him the power of the human spirit to make the most amazing things out of the most horrendous circumstances. (7:21)

Dr. Lakhia and Dr. Welshofer go on to explore the weighty question of whether doctors should discuss religious or spiritual beliefs with patients. Dr. Welshofer avoids spiritual questions, instead opting to approach the topic with subtlety. “I don’t really overtly do spiritual histories…I more just try to provide hope for people that don’t seem to have hope when day-to-day they’re going through significant difficulties. (11:52)

While a Doctor should avoid imposing their beliefs on patients, Dr. Welshofer encourages physicians to speak to their patients about their spiritual connections using open-ended questions, as it can help them maintain hope in desperate times, “don’t be afraid to ask a question, if it’s a benign question, you’re not forcing anything, just…how are you doing emotionally and spiritually with your problems?” (21:25)

Having treated thousands of patients in his career, Dr. Welshofer has identified two types of doctors, “You have doctors who treat the problems people have, and then you have doctors who treat people that have problems. If you're a problem treater, you get burned out. Because if all day long, you see 30, 40 patients…all day long it’s people bringing problems. As opposed to, if you're a people treater, then you get to know the patient and then the patient becomes personal to you. So, it's no longer ‘I'm treating the disc problem that Nancy has, I'm treating Nancy that has a disc problem,’ and there's a huge difference. (19:20)

• BlessBackWorldwide.org
• The Nature of Suffering and the Goals of Medicine by Eric Cassell
• Discussing Spirituality with Patients: A Rational and Ethical Approach
• The Importance of Spirituality in Medicine and Its Application to Clinical Practice
• Spirituality and Medicine
• The Positive Spirituality in Health Care: Nine Practical Approaches to Pursuing Wholeness for Clinicians, Patients, and Health Care Organizations by Dr. Fred Craigie
• Goodness of Heart

To contact Dr. Welshofer and Dr. Lakhia’s or to learn more about their practice, visit cnsa.com.

If you enjoyed this episode of Back Talk Doc, check out our episode The Recommended Diet to Reduce Inflammation. 

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.

Do you frequently suffer from back pain and don’t know the right way to treat them? Or do you think your home exercises are making the pain worse? Patients often mistake the difference between being physically active versus going to physical therapy to treat a specific injury, causing them to worsen the pain and fail to properly recover from herniated discs or muscular back strains.

In this episode of Back Talk Doc, our host Dr. Sanjiv Lakhia, welcomes Dr. Eleanor McMillan, a physical therapist who loves to exercise and enjoy a healthy lifestyle; she’s also helped numerous patients recover from painful back injuries. Dr. McMillan shares the virtues of physical therapy and how it can help you regain control of your life when suffering from back pain.

Dr. McMillan stresses that physical therapy has a specific purpose, a particular strength, and a frequency to help people; all patients are different, and you may wonder, what makes my pain better? What makes it worse? “Are your hamstrings tight? Are your hips weak? What’s your core look like? Or are your hip flexors very tight because we’re sitting at an office desk all day? Those are the kinds of things that we…look at.” (12:17)

Primarily, she wants to give her patients their lives back when they feel there is nothing they can do, like activities around the house or even gardening. “It’s just…teaching them activity modification, getting them the right dosage of standing tolerance, activity tolerance, how we can kind of slowly manipulate those variables to help out the patient and kind of give them their life back because they feel like they can’t do anything!” (16:44)

Dr. McMillan also tells us the steps to follow after recovering from disc or sciatic pain; how important it is to maintain your cardiovascular activity and the different exercises that can be done from home so as not to fall into the same physical pains again: ellipticals, swimming, static bicycles, etc.

For more information on patient education, visit our webpage backtalkdoc.com.

If you enjoyed this episode with Dr. Eleanor McMillan, check out our episode on Spinal Stenosis with Joe Cheatle MD.

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.

Although advancements in technology have made many things possible in medicine, particularly in the surgical aspect, robotics is still somewhat a relatively new concept. This sector is gaining traction in the market, but you won’t find robots in most hospitals in the U.S.

In this episode of Back Talk Doc, Dr. Sanjiv Lakhia is joined by neurosurgeon Dr. Chris Holland to explore surgical robots utilized in spine surgery. Chris goes in-depth into what surgical robots are, how these work, and how they’re adopted in the OR for neurosurgery or spine surgery. He emphasizes that these devices are not like what you would see in sci-fi movies. Rather, they comprise of a multi-articulating arm and an instrument at the end that performs a function.

He also speaks briefly on the history of surgical robots and their differences between the da Vinci robot. For the latter, the spine surgery robot is used as a guide for the correct placement of hardware, like screws or interbody cages. The benefits of using a robot and other challenges to adopting it in the OR were also discussed. 

Chris has a positive outlook on future innovations in the industry, which will provide increased safety and accuracy, along with lower morbidity rates among patients.

What is a surgical robot 09:22

How surgical robots work 11:26

Robots in spine surgery 13:06

Benefits of using a surgical robot 15:13

Challenges to adopting robotics in spinal surgery 23:03

Certifications and training 25:14

The da Vinci robot 27:14

The difference of spine surgery robots 29:23

Future innovations in spine surgery 30:27

Dr. Chris Holland's tips for health and wellness 33:00

Every episode of Back Talk Doc includes a Health Matters segment intended to provide actionable health information you can immediately put into practice in your life. This week, Dr. Lakhia talks about magnesium, an important mineral to maintain good health and well-being. He shares the benefits of magnesium, which include muscle relaxation, energy production, improved bone formation, and growth, There’s also a correlation between magnesium levels and back pain.

He also gives recommendations on what formulation of the mineral to take, including magnesium oxide and magnesium citrate.

Neurosurgical Robotics: A Review of Brain and Spine Applications - Journal of Robotic Surgery

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.

Replace defective joints in the knee and hips is not unheard of and there’s a big chance that you or someone you know has had this surgery done. But can this type of procedure be done to address issues in the spinal region?

In this episode of Back Talk Doc, Dr. Sanjiv Lakhia is joined by Dr. Dom Coric, who is an expert in spine trauma, spine surgery, and in particular, spinal arthroplasty. They dive deep into all aspects of artificial disc replacement surgery in the neck and lower back. Dom describes what happens during this type of procedure, which involves replacing the structural problem with an artificial disc, instead of the normally used spacers, rod screws, plates, etc. He also talks about the types of artificial discs that are typically used, how they have evolved through the years, and the differences between those that are utilized for the neck versus the lower back.

Dom discusses some exclusion criteria for artificial disc surgery. This procedure is recommended only for discs that are younger and don’t have spondylosis or wear and tear changes. Having healthy lumbar facet joints is an important factor as well.

Although this is a fairly new area in spine surgery and results are more visible long-term, there is a lot of cutting-edge research being conducted. And so far, the medical community is expecting positive outcomes with artificial disc replacement surgery.

What is artificial disc replacement surgery 06:27

Incidence of sacroiliac joint pain after lumbar fusion surgery 12:06

What is an artificial disc 13:19

Artificial disc for the lumbar spine 17:18

Types of devices for low back versus neck 18:49

Exclusion criteria for artificial disc surgery 19:55

Positive outcomes for disc replacements in the neck and low back 21:30

Decrease in incidence of adjacent level disease with disc replacement surgery 22:35

Shelf-life of disc replacement devices 24:17

Lumbar facet joints 26:32

Dr. Dom's go-to health habits 30:13

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.

Aside from clinical treatments for back pain and pain in general, acupuncture and dry needling are increasingly becoming part of treatment plans prescribed by physicians. However, there are misconceptions about these two interventions, with people often interchanging one for the other.

In this episode of Back Talk Doc, Dr. Sanjiv Lakhia goes into a discussion on dry needling and acupuncture and the significant differences between these two treatment options. It’s not so much as which is more effective than the other, but rather which intervention is the best course of action for your specific issue.

Generally speaking, acupuncture involves the insertion of needles in certain areas of the body to trigger positive physiologic responses. In dry needling though, your physician or physical therapist has to look at nerve and muscle patterns to identify and stimulate trigger points. While acupuncture is more of a system of care that can normalize other issues in the body as well.

He dives deep into the various scientific research studies that show the efficiency and benefits of these two interventions. These include increased blood flow to the pain area, releasing endorphins, a natural pain-relieving hormone, decreasing muscle banding, and triggering other sympathetic responses.

Dr. Sanjiv emphasizes that both dry needling and acupuncture are great additions to a comprehensive treatment plan. It’s important to consult with your physician to see whether these interventions can help alleviate and manage your back pain.

History of acupuncture 02:51

Origins of dry needling 04:24

Scientific research on dry needling and acupuncture 07:23

Physiologic research studies on acupuncture 11:10

Physiologic research studies on dry needling 12:42

Trigger points 15:02

Benefits of dry needling 16:27

Differences in acupuncture and dry needling 18:15

Contraindications 20:36

Resources on dry needling and acupuncture 22:45

Glute power with Ryan Klomparens, PT

All About the Thoracic Outlet Syndrome

Myofascial Pain and Dysfunction, The Trigger Point Manual

The Gunn Approach to the Treatment of Chronic Pain: Intramuscular Stimulation for Myofascial Pain of Radiculopathic Origin

Acupuncture Energetics: A Clinical Approach for Physicians by Dr. Joseph Helms

Getting to Know You: A Physician Explains How Acupuncture Helps You Be the Best YOU by Dr. Joseph Helms

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.

Besides cases of lower back pain, another common problem that most people face is neck pain. In severe instances, the pain shoots from the neck to the arm, which can lead to numbness and immobility. One condition that is often difficult to diagnose is the Thoracic Outlet Syndrome (TOS).

In this episode of Back Talk Doc, Dr. Sanjiv Lakhia is joined by Carolina Neurosurgery & Spine Associates’ nurse practitioner Emily Tucker and physical therapist Jay Murugavel in this roundtable discussion on TOS. Drawing from his expertise, Jay dives into what the thoracic outlet is and what causes pain in this particular spinal region. He talks about the various occupational risk factors connected to this condition, including certain sports like baseball and swimming, and working for long periods in awkward positions. You should also look out for things such as predisposing injury and congenital anomalies that can exacerbate

Treatment options such as surgery and physical therapy were also described, which are going to vary depending on the assessment of the patient’s clinical state. The goal is to minimize stiffness in the muscles and promote joint mobility. Breathing patterns also play a huge role in recovery and Jay encourages regular diaphragmatic breathing.

Emily provides valuable insight as well by sharing her personal experience with TOS, from diagnosis to treatment, and how she continues to manage her pain. She highlights the importance of listening to your body and your physicians and being compliant with the treatment plan devised by your medical team. 

Emily's experience with thoracic outlet syndrome 03:47

Consulting with a specialist 08:40

Course of treatment 11:16

What is the thoracic outlet 13:56

Occupational risk factors 15:11

Anatomical structures that lead to TOS 17:21

Difference between cervical radiculopathy and TOS 20:10

How to approach patients seeking treatment for TOS 24:02

Influence of breathing patterns on TOS 28:41

Activities to promote better posture 32:41

Looking beyond the spine to better diagnose and treat TOS 35:01

Jay and Emily’s health tips 37:40

Top 5 Non-Disc Causes of Low Back Pain and Sciatica

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.

One of the most common responses to feeling back pain is asking your physician for an x-ray to determine what’s causing it. However, the process of coming to diagnosis to properly treat any pain goes more than just reading off of an x-ray or MRI test result.

In this episode of Back Talk Doc, Dr. Sanjiv Lakhia gives a rundown on how physicians determine the proper dedicated imaging option needed for a patient. Numerous factors affect decision-making as each scenario is different. First, the doctor takes a look at the medical history and identifies any red flags such as a history of cancer, unexplained weight loss, and other neurological symptoms.

For many cases, if there are no alarming red flags, then conservative care is suggested first before undergoing any type of imaging test. When the pain isn’t managed after, then the physician may require either an x-ray, MRI, or CAT or bone scans. Dr. Sanjiv also discusses the best and most effective imaging option for certain spine conditions, including herniated discs, spinal infections, osteoporosis, cancer, and other rare conditions. 

At the end of the day, if your physician does not suggest any type of imaging, then you may have a low risk for any serious condition. Conservative care is always recommended to spare you any unnecessary testing and radiation. The majority of low back pain, in particular, is going to be self-limiting and with the proper management will resolve after some time.

Red flags that affect the physician's decision-making process 03:19

Low back strain 08:10

Radiculopathy 09:30

Herniated disc 10:43

Considerations bout gadolinium 12:45

Lumbar spinal stenosis 13:13

Cauda Equina Syndrome 15:27

Spinal infection 16:24

Malignancy or cancer 17:44

Osteoporosis 20:43

Disc herniations 22:14

Links Mentioned in the Episode

The Use of Imaging in the Management of Patients With Low Back Pain by Dinesh Rao

Worth a Shot? Spinal Injections with Dr. Andrew Sumich

Cutting Edge Surgery with Dr. Mark Smith

The Narrowed Path, Understanding Spinal Stenosis with Joe Cheatle MD

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.