Back Pain

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Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro Inc. where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine.

We discuss:

• Peter’s experience with debilitating back pain [3:30];
• Anatomy of the back: spine, discs, facet joints, and common pain points [14:45];
• Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:45];
• Why the majority of back injuries happen around the L4, L5, and S1 joints [31:00];
• How the spine responds to forces like bending and loading, and how it adapts do different athletic activities [36:15];
• The pathology of bulging discs [43:15];
• The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [46:00];
• The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:15];
• The significance of strength and stability in preventing injuries and preserving longevity [1:08:15];
• Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:30];
• Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:30:00];
• Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro [1:39:00];
• When surgical interventions may be appropriate, and “virtual surgery” as an alternative [1:46:45];
• Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:30];
• Tarlov cysts: treatment and surgical considerations [2:00:15];
• The evolution of patient assessments and the limitations of MRI [2:02:15];
• Pain relief related to stiffness and muscle bulk through training [2:07:00];
• Advice for the young person on how to keep a healthy spine [2:14:15];
• Resources for individuals dealing with lower back pain [2:25:30]; and
• More.

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In this episode of the Black Health 365 podcast, Jackie and Britt have a special guest - Dr. Christopher Newman, a renowned neurosurgeon from Memorial Sloan Kettering Cancer Center. The informative episode delves into topics such as spinal cancer, spinal tumors, neurological health, and spinal surgery. Dr. Newman shares his extensive knowledge and offers valuable insights into various spinal cancers and conditions. He also emphasizes the importance of listening to and prioritizing his patients' needs, drawing from his personal experience and passion for his profession. This episode will provide our community with a comprehensive understanding of spinal cancer and the surgical procedures used to treat it.

Dr. Newman is a neurosurgeon at the Memorial Sloan Kettering Cancer Center specializing in the care of people with primary spinal tumors, cancers that metastasize (spread) to the spine, and tumors involving the spinal cord and its nerves. He also has experience in using spinal cord stimulation to treat pain syndromes in patients with cancer and delivering medication intrathecally (directly to the spine), among other techniques. This expertise allows him to remove tumors precisely, manage pain syndromes, and minimize the effects of surgery on my patients’ quality of life. Dr. Newman is passionate about providing expert, compassionate, and personalized care that uses my advanced training in minimally invasive techniques (surgery done with small incisions or cuts), image guidance, and robotics.

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Eric Cressey (@EricCressey), MA, CSCS, is president and co-founder of Cressey Sports Performance, with facilities in Palm Beach Gardens, Florida, and Hudson, Massachusetts. He has worked with clients from youth sports to the professional and Olympic ranks but is best known for his extensive work with baseball players; more than 100 professional players train at CSP each offseason. He also serves as Director of Player Health and Performance for the New York Yankees.

Eric double-majored in exercise science and sports and fitness management at the University of New England and then received his master’s degree in kinesiology with a concentration in exercise science at the University of Connecticut. He has published books and video resources that have been sold in more than 60 countries. He regularly lectures both nationally and internationally, and his research has been published in The Journal of Strength and Conditioning Research. He serves as a consultant to New Balance, Proteus Motion, and Athletic Greens.

Eric has a free blog and a free newsletter on his website, EricCressey.com, and has a podcast at EliteBaseballPodcast.com.

Please enjoy!

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As I wrote in The 4-Hour Chef: “This is now, bar none, my favorite brewing method.” And now, exclusively for you, get free shipping and 15% off the new Crystal Clear AeroPress at AeroPress.com/Tim.

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This episode is also brought to you by Athletic Greens. I get asked all the time, “If you could use only one supplement, what would it be?” My answer is usually AG1 by Athletic Greens, my all-in-one nutritional insurance. I recommended it in The 4-Hour Body in 2010 and did not get paid to do so. I do my best with nutrient-dense meals, of course, but AG1 further covers my bases with vitamins, minerals, and whole-food-sourced micronutrients that support gut health and the immune system. 

Right now, Athletic Greens is offering you their Vitamin D Liquid Formula free with your first subscription purchase—a vital nutrient for a strong immune system and strong bones. Visit AthleticGreens.com/Tim to claim this special offer today and receive the free Vitamin D Liquid Formula (and 5 free travel packs) with your first subscription purchase! That’s up to a one-year supply of Vitamin D as added value when you try their delicious and comprehensive all-in-one daily greens product.

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[06:08] The email responsible for this conversation.

[09:19] Why pinpointing the cause of lower back pain can be so challenging.

[20:22] Initial diagnosis through movement.

[22:59] How seemingly unrelated meds can exacerbate pain.

[24:38] Posture considerations.

[26:55] Addressing and correcting suboptimal patterns of movement.

[28:55] Resources for understanding movement screens.

[30:00] Ingredients that make up a lower back pain cocktail.

[34:42] Even with the greatest care, wear and tear over time is normal.

[40:19] Improving thoracic mobility.

[43:56] Conquering Quasimodo.

[45:14] Defusing deskbound damage.

[48:25] Practical exercises.

[53:37] Shocking controversies surrounding fascial manipulation.

[1:02:18] Role of the glutes.

[1:04:02] Strengthening the posterior chain.

[1:06:06] Power and strength vs. aging.

[1:08:57] Recommended reading.

[1:12:21] Medical diagnosis vs. movement diagnosis.

[1:24:53] How to ask the right questions when seeking treatment.

[1:34:00] Overrated exercises?

[1:35:39] What a movement diagnosis will look like for me.

[1:36:23] Infrasternal angle.

[1:39:06] Age and injury predisposition.

[1:41:58] “Get long, get strong, train hard.”

[1:45:34] The downstream effects of orthopedic interventions.

[1:48:21] Creating bulletproof athletes.

[1:52:42] Worst advice given often.

[1:55:29] What has Eric recently changed his mind about?

[2:00:06] Important upstream variables.

[2:02:38] Good stiffness. (Oh, behave!)

[2:04:49] Vetting reliable sources of information.

[2:11:39] How Brijesh Patel changed Eric’s career perspective and other parting thoughts.

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When people ask me for an elevator pitch about what I do, the quickest, most accurate answer that I can give, is that I rehabilitate body image. Most people believe that Pain Care Yoga is all about stretching. And yes, Yoga for pain care may include stretching, but it's just one ingredient in a very complicated recipe. Each element is part of a process for building capacity and improving body image. This is a practice that includes all of the ways that I rehab body image; movement, stillness, awareness, and education.

Our practice will focus on releasing the low back, hips and hamstrings. Some of the postures and propping strategies in the practice are a little different. If you would like an image gallery of the postures to refer to, please visit https://yoga.mandyryle.com/rehabilitating-the-body-image/

Transformational Self Care
A Late Winter Wellness Retreat in the Dominican Republic
March 3-10, 2023

Join me for a 7 day Caribbean wellness retreat. Each day we will focus on a pillar of self care. By the end of the week you will have a group of new friends, some unforgettable memories and a personal self care strategy to enhance your life back at home.  Learn More 

Let's connect! Follow me on:
Facebook
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TicToc
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Free Resources:
Master the Yin Yoga Pose Repertoire: 7 Day Email Course
Introduction to Pain Care Yoga
Practice Gallery Workbook - 6 go to sequences with pictorial instructions

 For our final practice in this four part series, we will be working with the upper back, or thoracic region of the spine. For your exploration, I've borrowed a bit from a Feldenkrais Method® Lesson, the thoracic clock. If you are a movement geek like me, you will be blown away by the simple complexity of this somatic experience. Prepare to feel stuff you may not have felt in your back before. We will also be touching on one more important back related topic that can't be ignored. The influence that society and societal norms has on our experience of our back. This is a really juicy practice and it is especially wonderful if you suffer from upper back pain. 

Props Needed: Yoga blanket and 2 blocks

Transformational Self Care
A Late Winter Wellness Retreat in the Dominican Republic
March 3-10, 2023

Join me for a 7 day Caribbean wellness retreat. Each day we will focus on a pillar of self care. By the end of the week you will have a group of new friends, some unforgettable memories and a personal self care strategy to enhance your life back at home.  Learn More 

Let's connect! Follow me on:
Facebook
Instagram
TicToc
YouTube

Free Resources:
Master the Yin Yoga Pose Repertoire: 7 Day Email Course
Introduction to Pain Care Yoga
Practice Gallery Workbook - 6 go to sequences with pictorial instructions

Many who have back pain believe that their spine is unstable. There is a distinct feeling of instability and vulnerability in the back that is reinforced by confusing or misleading messages coming from popular culture and even medical professionals. Current research shows however not that people with back pain are not unstable, but too stiff! In this short practice we will gently explore that stiffness and seek to restore subtilty and differentiation to the movements of the back, especially the spine and ribs.

This is the second episode in a short series "Getting to Know Your Back". You are free to take the classes in any order.

If you are interested in exploring an evidence informed approach to healing back pain, check out my free e-course "Introduction to Pain Care Yoga". You can enroll here and start today.

Transformational Self Care
A Late Winter Wellness Retreat in the Dominican Republic
March 3-10, 2023

Join me for a 7 day Caribbean wellness retreat. Each day we will focus on a pillar of self care. By the end of the week you will have a group of new friends, some unforgettable memories and a personal self care strategy to enhance your life back at home.  Learn More 

Let's connect! Follow me on:
Facebook
Instagram
TicToc
YouTube

Free Resources:
Master the Yin Yoga Pose Repertoire: 7 Day Email Course
Introduction to Pain Care Yoga
Practice Gallery Workbook - 6 go to sequences with pictorial instructions

Rob and Dave talk about all things MRIs in this episode and share great information on the role and importance of MRIs as part of the medical diagnostic toolkit for back pain

They also discuss why it’s the reporting and lack of presentation that can be the problem and how this information must be used in correlation with other symptoms for a working diagnosis.

If you have ever wondered why, you weren’t offered an MRI, refused one when you asked or want to understand more about MRI’s and back pain then this is the episode for you

KEY TAKEAWAYS

• An MRI is a fantastic diagnostic tool it’s the reporting or lack of reporting that can be the problem
• An MRI shows everything that is under the skin and most people will have something that can be blamed for the pain
• Standardising the regular use of MRI’s can potentially lead to attributing some normal age-related factors with pain and going down the wrong route
• It’s about the correlation with your other symptoms and looking at the overall picture of presentation
• It’s important to make sure that information is carefully shared so there is an understanding
• MRIs are an incredibly important part of the medical diagnostic team but it’s about being careful about how the information is disseminated
• Therapists know from the assessments they complete what the red flags are and what they are looking for
• A ‘just in case’ MRI can be confusing because it shows everything
• With an MRI you must take into account all the other diagnostic information
• A red flag raises the suspicion that there may be something else going on, but it doesn’t mean there actually is anything to be concerned about
• If you do self-refer for an MRI, then take the report to your professional

BEST MOMENTS

‘It’s the presentation or lack of proper presentation to the patient that is the problem’

‘We know pain is multifactorial’

‘Therapists are really good at knowing what the red flags are’

‘Words and presentation have to be chosen carefully’

THE BACK PAIN PODCAST PROVIDER MAP - FINDING SOMEONE TO HELP YOU WITH YOUR BACK PAIN

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The Back Pain Podcast

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ABOUT THE HOSTS

Dave Elliott

Dave is the owner of Advanced Chiropractic, a chain of Chiropractic and massage therapy clinics in Essex, UK. Dave still sees patients during the week but has been working hard to talk to as many experts in the field of back pain as possible to help distil all the information and bring it to you in this awesome podcast. You can find Dave on any of the Advanced Chiropractic social media platforms, or you can contact him at hello@thebackpainpodcast.com   if you have any questions for him.

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Rob Beaven

Rob owns and runs a multidisciplinary clinic, The Dyer St Clinic in Cirencester Gloucestershire. His team of Chiropractors, Physiotherapists, Osteopaths, Doctors and podiatrists all collaborate on thousands of back pain patients every year. Alongside Dave, he has worked hard to bring to the table experts across all industries to give you the low down on back pain, with steps you can implement today to start feeling better.

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CONTACT US

hello@thebackpainpodcast.com

Support the show: https://thebackpainpodcast.com

Welcome to this week’s episode of The Essential Strength Podcast!

Today is Episode 20, which feels like a big one! It’s one of those nice round numbers that feels like a milestone and we’re lucky enough to have a big guest for today! We had the chance to sit down for an hour with Stefi Cohen and Ian Kaplan of Hybrid Performance Method to talk about their new book, Back In Motion.

For those who don’t know, Stefi Cohen is The Co-Owner of HYBRID Performance Method, a Doctor of Physical Therapy, 25X World Record Holding Powerlifter, author, educator, creative thinker.

Ian Kaplan is the COO of HYBRID, Doctor of Chiropractic, Coach, data science enthusiast and creator of the HYBRID Tech Stack.

We get into what makes Back In Motion a completely unique book, but to set the stage, I’ll steal the words directly from Stefi and Ian: This book is NOT about diagnosing back pain. No anatomical diagrams of the spine or sophisticated discussions of neurophysiology. It is a book with real world knowledge that will empower you to find your unique path leading back to doing the things you love.

Today’s episode is a fascinating look into the minds of two people who are LITERALLY re-writing the book on how health and fitness is developed and delivered and doing things no one has ever done before.

Links

• Back In Motion - to order your copy CLICK HERE
• Hybrid Performance Method - to learn about the business and everything they offer CLICK HERE
• To connect with Stefi on Instagram - CLICK HERE
• To connect with Ian on Instagram - CLICK HERE

Action Plan

This week's action plan is based on a specific part of today’s conversation, in which Stefi asked a difficulty, but vital question about who has responsibility for accurate knowledge - the provider or the consumer? I stand by my answer that, while both parties share responsibility, ultimately it is the provider who has more power and therefore a greater share of the responsibility. So, here is what I would like you to do - I want to you to think about or write down a couple areas of your life where you have “the power”, where you control the narrative, and I want you to really make sure that you are doing everything you can to be accurate, honest and empowering. This could be in your role as a parent, as a care provider, as a supervisor or any other part of your life. When you control the story, you have a responsibility to make sure that story is based in an accurate reality, not steeped in self-serving bias. I hope this exercise leads to some positive realizations and perhaps a sense of peace.

Until next week, we wish you STRENGTH and GOOD HEALTH!

What’s up everyone, it’s David back with this weeks episode of Health and Fitness Friday. Your bite sized podcast meant to make you a little smarter and a little stronger at the end of every week.

We’re still riding the back pain train this week, but we’re taking it BACK IN TIME.

Back Pain seems like a modern dilemma. We sit more and more for our jobs, we sit and watch Netflix at home, we sit in our cars and therefore we have back pain.

People probably didn’t have back pain before our lifestyles became sedentary, right? Actually, not right. We can look back as far as 3,000 years ago and find documented cases of back pain. Now, back in the day - meaning like, 1500 BCE - we don’t have statistics to tell us the per capita case rate of back pain or anything of that nature, but we can say that some of the most influential names in the history of science and medicine were pondering back pain, what caused it, and how to treat it, many many centuries ago.

And now, at least 3,000 years into the written history of back pain, we still don’t have a discernible cause for 95-99% of low back pain cases. Interesting enough, as is often the case, our most modern paradigm of back pain is actually beginning to resemble more closely some of the most ancient definitions, rather than what we have considered “fact” in the interim. 

A lot has changed in the last 2500 years, but we are still trying to figure out what people experience low back pain, what structures are at fault, how to address back pain effectively and create lasting results. We’ve developed advanced surgical techniques, diagnostic tools and imaging systems, and written countless thousands of articles and books on anatomy and pathology. And yet, the current wave of back pain treatment focuses less on the biomechanics structure and more on the the entire picture. The biopsychosocial model acknowledges that our strucutre, our thoughts and our environment cannot be separated, but must be considered as equal parts of a whole if we are to understand and treat pain. I don’t know about you but to me, it sounds like we’ve returned in large part to where we were 2500 years ago when Aristotle noted that pain is a “passion of the sole.”

Catch Ya’ll next week!

Last week we began our conversation about pain and the importance of continuing to find ways to stay active and keep mobile even in the presence of pain. Today, we are going to zoom in a little bit and discuss Low Back Pain and the state of the literature as it relates to what does and does not work when it comes to exercises designed to rehabilitate chronic low back pain.

In particular, we’re talking about the findings of a literature review published in December, 2018 that looked at various common exercise paradigms used to address low back pain and how they affected pain, disability, quality of life, strength, mobility and flexibility. 

Before we dive into some details - here is the Great News: This review found that every single approach - be in Pilates, Global Postural Rehabilitation, McKenzie Exercises, etc. - every approach was effective for reducing pain, disability and improving quality of life AND the effects help up over time. These exercise-based interventions were also MORE effective than a pharmacological intervention at reducing disability and improving physiological outcomes like strength and flexibility. No single approach was clearly superior to the others given the current state of the literature.

Long story short - if you have chronic low back pain, and you seek treatment - find a practitioner who will utilize active, guided exercise as a first-line strategy for improving your pain.

To read to original research article - click here

Reminder!

If you are a coach or a trainer and YOU want to improve your ability to work with clients who have aches, pains or injuries don't sleep on Michael Mash and his Barbell Rehab Workshop - as an Essential Strength listener, you can take $25 off the price of the online version of the workshop by using the code "stronger25" - and remember, this workshop counts for continuing education credit for pretty much every major accrediting body so if you're in need of hours to maintain certifications - this is a great option!

Catch ya'll next week!

In this episode Dr Heptulla and Dr Gorbal discuss back pain it’s causes and treatment