The Chris Voss Show - The Chris Voss Show Podcast – SPECIFIC SPINE: A Doctor’s Guide to Back Pain Relief – Written for Clinicians, Therapists, Trainers, and Ordinary People with Back Pain by Lysander Jim M.D.

Episode Date: September 24, 2023

SPECIFIC SPINE: A Doctor's Guide to Back Pain Relief - Written for Clinicians, Therapists, Trainers, and Ordinary People with Back Pain by Lysander Jim M.D. Masterymedical.com Are you puzzled by a disc bulge? Disheartened by unsuccessful physical therapy attempts? Considering surgery? In this comprehensive introduction Board-certified spine specialist Lysander Jim, M.D. reveals the mysteries of the human spine and low back pain. Learn expert insights about the fundamental cause of most back pain. Navigate the complex decision of whether surgery is the right path for you. Master posture and movement techniques to nurture your spine back to health. Discover actionable advice on choosing the ideal mattress, chair, and car seat to wind down your pain. Learn rehabilitative exercises accompanied by step-by-step instructions and illustrations. Don't endure the discomfort — the journey to healing begins with understanding. Dr. Lysander Jim is a Board-certified Physical Medicine and Rehabilitation doctor who specializes in the treatment of low back pain and immunological conditions arising from damp building exposure. He graduated from the University of California, Berkeley with a bachelor’s degree in psychology (2007) and earned his medical doctorate (M.D.) at the Albert Einstein College of Medicine (2011). Dr. Jim then completed a medical internship at new York hospital, Queens before completing his training. In 2015, Dr. Jim completed his residency in Physical Medicine and Rehabilitation with top scholastic honors at the Veteran Affairs Hospital/University of California in Los Angeles.

You wanted the best. You've got the best podcast, the hottest podcast in the world. The Chris Voss Show, the preeminent podcast with guests so smart you may experience serious brain bleed. The CEOs, authors, thought leaders, visionaries, and motivators. Get ready, get ready, strap yourself in. Keep your hands, arms, and legs inside the vehicle at all times, because you're about to go on a monster education rollercoaster with your brain. Now, here's your host, Chris Voss. Hi, folks. It's Voss here from thechrisvossshow.com, thechrisvossshow.com. Welcome to the big show show my family and friends ladies and gentlemen children of all ages welcome to chris bosh show the family loves you but doesn't judge you i mean what better things

can you have you know we all those families that you know you got a few bad family members in there maybe you have a family you just have a few good family members in there but the chris bosh show is a giant warm wonderful family that loves you just the way you are as long as you're you know not evil we don't want evil people in the thing you know you're not like trying to overthrow a country or something but other than that the chris faust show loves you and doesn't judge you so uh we're going to be talking about you know we we joke in the show about having talking about brain bleed we're going to be talking about some spinal stuff maybe some spinal bleed i don't know there's not going to be blood maybe there will be who

knows just stay tuned to find out we're going to talk about the spine health and all that sort of good stuff today on the show with an amazing brilliant doctor he's going to give me some of his insights and i'm going to of course uh do the thing i do with every doctor i'm like does this look infected so it's always a great party yeah when you meet doctors always go up to them at the parties and say that to them you know just you meet them oh your doctor hey does this look infected and like uh i don't know pull your pants down anyway guys uh he is the author of this book june 1st 2023 don't do that people don't do that, people. Don't do what I said before. His name of his latest book is Specific Spine, A Doctor's Guide to Back Pain Relief, written for clinicians, therapists, trainers,

and ordinary people with back pain. Lysander Jim, doctor, I should say, Dr. Lysander Jim is on the show with us today. We'll be talking to him about his amazing book. And if you've ever been one of those people who has some back pain, I seem to have a lot. I think I've done a couple of things to some discs or, or bulges or whatever's going on back there. Sometimes this isn't always right, but, uh, I've done it and I think all of us have done

it or we'll do it in our old age. So are we talking to him and maybe we can get some reassurances or figure out what the best cause cause or cause of modality or cause to get it fixed dr lysander jim is a board certified uh physical physical medicine and rehabilitation doctor who specializes in the treatment of low back pain and immunological conditionings arising from damp building exposure. He graduated from the University of Berkeley, California, Berkeley with a bachelor's degree in psychology, and he earned his medical doctorate at the Albert Einstein, I've heard of that guy, College of Medicine.

Dr. Jim then completed a medical internship at New York Hospital, Queens before completing his training. In 2015, he completed his residency in physical medicine and rehab with the top scholastic honors at the VA Hospital at the University of California, Los Angeles. Welcome to the show, Dr. Jim. How are you? Hey, thanks, Chris. I'm doing great. And it won't be the first time someone approached me and asked me medical questions. Do people do that to doctors or is that just me? No, no, that's a real thing. I mean, it's almost like the more, it's actually more comfortable when it's a stranger.

It's just the closer they are to you, the more it's kind of like, hey, maybe I shouldn't be the one to look at your rash. Because I have to look at you at Thanksgiving dinner. Yeah, I have to see you at Thanksgiving dinner. So I don't know where this rash you're referring to might be. Hey, Duncan, I went to Thailand. Take a look at this. Can we get that cleared up? And you're like, does your wife know about this? Because I saw her at Thanksgiving dinner. I'll see her at Christmas and then I have to go to she. I don't know about that because I saw her at Thanksgiving dinner. I'll see her at Christmas and then I have to go to see her. I don't know what's going on.

So there you go. So GiveUsA.com, where can people find you on the interweb, sir? We are, our clinical website and some of our articles on masterymedical.com. That's the name of our clinic as well. There you go. There you go. And how long have you been doing, how long have you been running your clinic? The clinic has, it's on its seventh year now.

Congratulations. Awesome sauce. There you go. So give us a 30,000 overview in your words of what you do and how you do it. The 30,000 view is I'm a doctor who specializes in mystery illnesses. It's a back pain that doesn't go away despite seeing multiple doctors or the chronic fatigue, fibromyalgia type problems that people mysteriously get. And so then the clinic, the whole rationale for it is sometimes the best science doesn't get translated into clinical medicine. There's this lag often that's described of 17 to 21 years from when something is really figured out in the scientific papers, journals, scientists for it to get to clinical medicine, which tends to move slowly, almost like this big lumbering ship that takes forever to turn its course. And so being kind of a small clinic, a solo practitioner, I thought, well, these are the insights I have

from mentors who've taught me from scientific kind of learnings that I have. And I thought, why don't we apply that and bring that to patients faster than that 17 to 21 years? There you go. You know, I had a mystery, I had a mystery pain where I was having lower back pain, just a really low back pain. And it was really hurting a lot. And the doctors could not figure out what it was. They go, I don't know, Ben, you have a lot of lower back pain and you seem to be in a lot of pain. And then I just broke up with someone and it all went away. So it was just a pain in my ass. All right. Enough.

You probably get a few of those jokes of being a doctor in the business. So, uh, give us your story. It wasn't that funny. I like the delayed laugh. The pity laugh. Thank you.

Thank you, Dr. I didn't know how much you're going to talk about your ex-girlfriend. I was giving you space to process that. Oh, okay. You want me to, that was all we had. I was a psychology major in college.

So it, I mean, people's, the blessing of being a doctor is you hear about everybody's life. And the thing is people's psychological state, their relationships, that's part of their experience. And sometimes that mitigates people's kind of how they feel too, so. All my girlfriends are wonderful. That's just of their experience. And sometimes that mitigates people's kind of how they feel too. So all my girlfriends are wonderful. That's just a joke.

I don't write to people. Uh, I'm getting text messages right now. Uh, so, uh, give us your origin story. Give us a history of you.

What made you interested in, uh, you, you did psychology and then you decided to do a work and what made you landed you in the spine business? It, it started off with I was always this bookish person who wanted to read and learn all the time just for its own sake for curiosity's sake and so I was a little adrift in college in terms of what I wanted to do I was

interested in psychology I thought I might become a psychologist. I worked at a crisis hotline, crisis and suicide hotline. And one day I was thinking, well, this is kind of intense to talk, you know, just on a purely psychological level, dealing with the mental health alone. And then I was visiting my cousin, who was a high school student at the time, and I started reading his high school biology textbook. And I was just like, oh, I remember reading about the heart. Why don't I read that? And then it struck me that if I didn't become a doctor, then all this learning and interest I had in health was a bit of a waste. And so I thought if I become a doctor,

then anything I learn could potentially save someone's life. So there's that part of that savior complex that some of us have. And also, it would just make everything I learned suffused with meaning. And so from there, I found the field of physical medicine and rehabilitation, we see the back pains, the joint pains, the neurological conditions. And so I was out of residency at a pain clinic where my primary job was to prescribe opioids and other painkillers to people. So that wasn't exactly the type of kind of knowledge set that I wanted to base my entire career out of. I felt like I helped people, but opioids clearly have a lot of risks and dangers. So one day I got a call about a mutual patient

who it was discovered was diverting the opioids to sell them. This local sports medicine doctor said, oh, this mutual patient, she was a young lady, like kind of seemed like a very kind of solid citizen, but apparently she was diverting the opioids had me fooled. So we kind of lamented about how sad it was. And he told me about a book called Low Back Disorders and how it was written by this professor of biomechanics named Stuart McGill and how the principles in his book were a much better way to treat back pain. And I said, no, sign me up. I'll get it on Amazon today because I don't want to. You know what we're taught often is just to cover the symptoms, give the painkiller, refer procedures, et cetera. And physical therapy is wonderful. But what if you refer them to five rounds of physical therapy, and they're still not getting better? What do you do

then? And so that book answered, you know, virtually every big question I had and showed a better way forward that was based in science nice and then so so from there my interest in back pain grew with my ability to impact back pain so when i was at the pain clinic the back you know i sometimes refer to back pain it's it's like the dragon of all joint injuries it's the final boss people don't understand it people get addicted to opioids they get failed back surgeries because of it. And here was somebody who had figured out the, you know, put everything together scientifically and clinically to figure it out. And and then seeing the impact, it felt it felt like a almost

like a miracle to even diagnose somebody specifically, because, you know, like in your story, the patients who we see, they have that same story, no one's figuring out, you know, like in your story, the patients who we see, they have that same story. No one's figuring it out. You know, there's a lot of tears. There's a lot of depression. And then when you're able to figure out, and for many of them, once you figure out what's going on, that's when you can actually solve the problem. There you go.

Diagnosis is probably much of the battle, half the battle or something. I don't know if that's true. I mean, the analogy I love is I heard that, I don't know if that's true. The analogy I love is I heard that. I don't know if this is true or not, but they said in hunter-gatherer society, who ate first? Was it the person who speared down the mammoth? It wasn't. It was the person who first spotted the animal. And then I think that that makes sense because if you know what's going on, like let's just say I told you some mystery condition, no matter how obscure it was.

Once I told you what condition you have, you said, I can Google this. I could Google scholar it. If I'm going a level up, I could find specialists. But until you kind of get to that level of detail, then you're lost. There you go. So, well, technically that's his affiliate fee for, for finding the animal. That's what that is. That's why they found for finding the animal. That's what that is. That's why they found him first.

Yeah, that's from the content producer role. Yeah, he's got the whole affiliate fee. You know, you get the referral fee. There you go. You know, so the great thing is, too, is you have this background in psychology. So have you ever tried going up to one of those back discs and saying, you know, why are you broken like did your mom not hug you enough as a child or something well it's that's one of the big debates

i mean no i mean it's like a uh yeah it's a very interesting topic because there's this book called um healing back pain by by dr um john sarno and that's one of the biggest debates in spine medicine is actually, you know, some people will have that, is are you having back pain because of all your repressed emotional issues, or are you having a physical problem? And some people come in and then they're often saying, well, I read this article that said, you know,

it's my bad marriage that's causing my back pain, my, you know, my stresses about life. And some, it's, I mean, that's my it's my bad marriage that's causing my back pain. My, you know, my stress is about life. And some it's I mean, that's this whole topic in itself. But in a nutshell, it's this idea that pain is a psychological experience, even if it has a physical cause. And sometimes some people are so stressed out that they can have kind of neurological symptoms from it. Some people call it a conversion disorder. And it's the quick example I kind of give from there is that cartoon King of the Hill. And so there's this one episode where Hank Hill sees his mom, you know, his like elderly

mom walks in on his mom and her boyfriend and he goes blind. And then so that's kind of the the quick way of like that's conversion disorder it's like nothing happened to his eyes can somebody be so psychologically injured that they develop physical so you know or neurological symptoms so i think that's um that's always in the background and and that's one of the the big debates and and things we're trying to figure out i would say usually most of the time it's primarily a physical injury. And then if the person has stress and other things going on, that makes the symptoms worse. But then, yeah, but we could go into that rabbit hole if you want.

There you go. Well, I can validate that because most people go blind when they see me naked. But usually it's because of the... they're going blind in a good way mostly it's because my skin's so white and pale you can't believe how lucky they are like oh my god it's an eclipse and uh then i have to turn to the side so that the eclipse anyway whatever um so give us a overview of the book what's inside of it and the details of specific spine yes the title of the book. What's inside of it and the details of Specific Spine? Yes, the title of the book, Specific Spine, refers to this idea that you can know specifically what is wrong with the spine with the right clinical assessment. And I try to build it from, for many people, this might be kind of like a boring structure.

I just try to take you from the ground floor up. What's wrong with spine care? What's spine anatomy? How does the spine work? How does it break down? How do you figure that out? How do you fix it with posture? How do you fix it with exercise? So it kind of takes a ground up approach. And it has a lot of the tactics and everything. But it's really for the person who very much wants to understand what's going on with them. And it kind of takes you along in terms of intellectually, what I kind of was able to learn and piece together through my medical

education and through what I learned from professor McGill as well. There you go. The spine is real important part. Last time I checked, although I don't know, there's some politicians that are spineless. So maybe this helped for them or not. Maybe this is not.

But you talk in the book about how to choose an ideal mattress, a chair, a car seat to help wind down pain. So this sounds like some really good advice. Even rehabilitative exercises with step-by-step instructions and illustrations. So that's got to be really handy to have because there have been times in my life, especially when I used to be super stressed and I didn't go, you know, get massages and get a good massage chair and eat healthier and stuff,

where I used to suffer from a lot of pain sitting a lot too in business as well. So it sounds like there's some good advice you give in that way so that the average person can maybe deal with their back pain. Oh, yes. I mean, one of the keys to solving back pain is to kind of engineer your life so that you're not falling into your pain. So, you know, we have people who say, you know, I drive, you know, 50,000 miles a year for my business. They're like a CEO or something or I'm flying this many miles a year. But then if you put your spine in a condition where it's constantly getting triggered and

in pain, then you never really have a chance to heal. And one of the secrets for most back pain is it could heal, but it doesn't because you're never taught about the postures, the movements, the activities, and the exercises that might be unwittingly pushing you further into your pain. So that's really the central insight is, yeah, there's some cases where you're not going to fix it without surgery, or sadly, they're not fixable with any kind of intervention. But for most back pain, over 90% of back pain, if you could be taught the right postures, movements, exercises. And so it's a 360 thing. It's not a pill. It's not just an exercise. It's really that background. Some people use the term spine hygiene, like how you have to kind of have this lifestyle where

you're not overwhelming your injury and your back. There you go. Let me ask you this, because my family, I think my mom said this, I don't know if this is even a scientific for it, but, you know, our family, at least with her and I, we're both sea sitters. Is that really a term? Like, you guys think of it, it's where we slouch like this. We kind of sit over at a seat. Is that like, is that a real medical term c-sitters i don't know it's i mean it's a the idea is i mean we talk about that in in spine medicine i mean c-sitter is probably a great term we should use more because it captures that kind of rounded you know in medical terms we call flexion but c-sitting actually is much more intuitive to

people than technical terms and so c-s sitting is usually associated with an increased stress on your back. So compared to standing, sitting increases the load because you're not putting the load through your legs anymore. You're basically compacting your spine. And when you're bending your spine, like rounding your spine, you're putting further load on this, stretching the ligaments in the back of the discs. You're setting the conditions for disc bulges and other types of injury like that, tears in the disc wall. And that's the mystery for most people. They said, well, I've been doing the same C-sitting for 30 years, 50 years, and I had no back pain until now. And that's the big thing is

just because something didn't cause you symptoms doesn't mean it was good for you so the leading symptom of a the number one presenting symptom of a heart attack is sudden death so where was all that chest pain earlier on it's as well some types of injuries and problems they don't have symptoms until it gets very bad. And that's often the case with disc injury is most of them are actually from your overall pattern of postures, movements, loads. And then so maybe maybe you had a fall and that hurt the disc, then all the sitting stressed it further. But it's kind of this whole build up. It's usually for most people, it's not a single event, though, there are clearly, you are clearly sporting, lifting injuries where most of the damage happened in a split second when something dropped on them or something.

Oh, wow. Yeah. You know, the sad thing about it is when you injure your back, it's kind of hard really to repair. I guess it depends on what you do, right? Yes. Many injuries are slower to heal compared to other parts of the body let's if we use disc injury as an example there's a there's really one or two main reasons for that so earlier we said you can damage the disc so much because without pain which

seems kind of you know like why would that happen you know if i hurt my elbow if i hit my elbow i feel the pain the this the secret to all this is the disc is the biggest part of your body that does not have its own blood supply and then so so then it doesn't have its own blood supply so it's kind of relying on nearby you know it's kind of scavenger in a way like nearby nutrients and oxygen drift to it and it's also one of the largest parts of your body that doesn't typically have nerve endings on most of it so so then it's if something doesn't have a nerve ending that's like your nails your nails are growing but if you clip your nails you don't feel any pain because there's no nerve endings in there so much of the disc when it's healthy um it doesn't have nerve endings.

So that's why you could tear your disc wall. You can kind of create a bulge where the inner material, the inner gel gets shifted around. And it doesn't become painful until something that does have a nerve ending starts getting affected, like a spinal nerve. So let's say this bulge grows larger and larger and it presses on a spinal nerve at the back of the spine. All of a sudden, you have sciatica that happens seemingly overnight but it's kind of like these overnight success stories right it didn't really happen overnight it was building up there was all these things that were causing it to happen just stacking up and and then it hit you one day and i know the the other one of the other issues is uh you know just age right yeah is yeah i mean age causes certain problems to to kind of manifest but most old people believe it or not have less back pain

than some of the young people oh really yes yeah we have because it's when you're younger your juices your your i'm not used your your disc has more kind of hydration and then so it's it's when you're younger, your juices, your, your, um, not these, your, your disc has more kind of hydration. And then, so it's, it's more, it's a stiffer, more pliable thing. So in a younger crowd, you see these, you can see some fairly severe, um, disc injuries, usually as people age, the, the disc, it starts to dry out and that can certainly cause some problems, but it actually prevents other types of problems from being as bad either. Usually a person who's older,

we know we tend to stiffen up and gristle up as we get older. So that's bad on one front, but it also prevents certain types of instability, injuries from happening too. Wow, there you go. There you go. So do you work with people all over the country?

Can they fly to you? Is there a specific area that you cover? But I think it's also an indictment of, well, like this disc injury is a very common thing. But then and chronic pain is, you know, most people either have it, have had it or know somebody with it. But we do. Yeah, we work with people throughout the country who fly in for consult. There you go. And you work with insurance and all that good stuff. Now, you refer to on your website the McGill method. Now, you've written your own book and then there's the McGill method books. Tell us how that works. The McGill method is the approach developed by my mentor and Stuart McGill.

He's a biomechanist, a retired professor, and he became a clinician and is considered, you know, arguably the leading or a leading spine clinician. So I learned about him after reading low back disorders, and how I would say what is the McGill method, it's applying the scientific knowledge to clinical care when it comes to diagnosing and treating back pain. It's certainly connected with a few kind of key exercises but it but it's very much a more of an approach than any specific technique that exists within it and so it kind of covers it spans this whole world of different things like anatomy and radiologies you know spinal imaging the exercise and performance domain into kind of one coherent skill set there you go there you go well you know anything that can help with backs you know i had one friend years ago who uh he'd had a really bad car accident he'd

been involved in and uh he had one of his discs think, blown out or whatever the correct term is. And then the other one was injured, and they started fusing his spine. And he started explaining to me, he's like, yeah, eventually, once you start fusing the spine, I guess everything else starts getting off track, and you eventually end up with a fused spine. I don't know if that's correct or not, but he was telling me about it. I'm like,esus dude and he was getting to the point where he's really fighting to to keep his quality of life in place with a cane and not going to a wheelchair because of what was going on with his spine so it was he

was only in his 40s it was really unfortunate yeah no i'm sorry to hear that i mean the surgeries i mean if you have such a big traumatic injury, oftentimes you do need a surgery to restabilize it. And the idea of a fusion surgery is you're putting hardware into the unstable area. And once the hardware is there, then your body has the ability to grow bone and stiffen that area. So that stiffening of that area is part of the healing process that's what the all the all the scaffolding it's really more scaffolding to allow your body to build a bone around it and and but what happens though is if the person is never taught how to move properly they're not going to bend where they're fused but they're going to bend they call it at the adjacent

segment it's kind of like neighboring area that can bend well bend. And then so some patients start developing injuries at those adjacent segments, and then that creates a new instability. And then that's when you can often see a multi level fusion, it sounds like what happens to your friend. And then sadly, the quality of life of people who have failed back surgery i mean it's among the worst conditions in terms of the impact on what a person can do and the amount of suffering that it causes yeah and and you can't go back i mean there's a couple things they'll learn in life that once you break them you're just you're stuck with them um like i wish i hadn't done that but you did it and there it is uh it's kind of like my

first five children no i'm just kidding i don't have any children that's a joke people uh i know everyone's already dialing 9-1-1 on you he's like that utah oh yeah we thought you were yeah they've been with me for 15 years they know my callback jokes uh so there you go uh so this is really important you know like you talk about your book uh advice on choosing the ideal mattress car car seat i injured my back years ago moving in my lower back and i for the longest time could not sleep on a normal mattress i would have to sleep on the floor with a thin pad and I had to keep my spine back or if not, I woke up in the pretzel and not in a very happy condition. And then I finally found a really good mattress that works for me that came from Eight Sleep. And then of course,

what's beautiful, it comes with the heat and cooling and stuff. And that thing has been a lifesaver. I mean, I've spent 20 years, I spent 20 years where I couldn't have like a normal mattress. If I had a normal mattress, I had to put like a plank down and then put my foam thing on top of it. Because if I travel and go to hotels, I can get really messed up. But I but i don't know it's been a couple years i've had the eight sleep bed uh maybe i can go back to normal beds i don't know but uh it can affect your whole life it can really screw you up and so it sounds like you have some good advice there how to refine the ideal mattresses chairs car seats we've been talking before the show and i mentioned that there was a some commercials for um patented

pain pressure relief seat cushions from some different vendors on on uh amazon that popped up so uh it sounds like there's a lot of different things out there and like you two mentioned too you've got to kind of learn how to move better where you don't throw your back out oh yes the the posture movement quality that's the foundation to most healing yeah it's it's if you have to the first step really is to figure out you know with you know professional help what's what kind of movements are triggering your pain and the idea of avoiding your pain is it's it might be surprising to hear but it's not intuitive to people most people especially the patients we're fortunate to see,

they have this kind of grit mentality where if something hurts, I'm just going to push right through it. And then that's great for maybe building a business and performing in sports, but it's actually harmful to rehabilitation. You actually have to avoid pain and that's what allows your your spine

to start to heal ah there you go there you go and probably you know how you sit affects how it heals and maybe how the bone regrows and everything like that like you're probably i'm sitting here hunched over i can see myself on camera um you know and that that's one of the things you know have you ever seen those things where they do where they've got like some straps that pull your that pull your shoulders back i've seen those things i have those things are those things crap or is it just uh it depends so there so i think that one of the big um aspects is what is good posture i think and then so normally let's say you have no injury good posture is what's called neutral so it's not it's not rounded it's not sea sitting type of situation but nor is it military everything's pulled back too much but once a person has an

injury though the ideal posture it might not be the neutral posture anymore, because the neutral posture might actually stress your injury out. So it's usually some posture that is maybe close to neutral, but it's maybe a little bit flexed, maybe it's a little bit kind of upright. So let's say we have somebody who their main pain is when they cease it when they round their spine, they do a sit up. And so for that type of patient, something that encourages them to be more upright, maybe a little extended can be helpful. But that said, there are people who have pain when they're arched too much, we see a lot of these people, and they come in and they think, I have great posture already. So I don't really know what you're going to teach me but what they don't realize is that their so-called good posture is is actually stressing out their injury and I can often show

that that to them in real time I say okay let's let's make you even more tall and then they they'll oh that hurts then we tune them into a position where we help help them maybe adjust the position of their pelvis and then their their back rounds a little bit. And then they'll say, oh, actually, this kind of rounded C-sitting type position feels better for that type of injury. So that's kind of where you're looking at the pattern of what hurts. And then that's guiding you to what is actually safe for you. Ah, there you go. Now, what causes disc bulge?

And why does some disc bulge is not hurt? Now I have, if you go down my spine, there's the area that I injured years ago, decades ago, and it sits a little funny. Yeah. You can kind of tell. In fact, I can find it in my back. Um, but it doesn't ever hurt. I I'm, I'm pretty, I never have any real problems with it. I'm always careful when I lift stuff and things, and I try not to do anything to piss it off. But, you know, I can't remember the last time I buggered it. But why doesn't it hurt? I guess.

The main reason many disc boulders don't hurt is the disc is the largest part of your body where most of it doesn't have nerve endings. And, and then because of that, you can tear your disc wall, you can, you know, bend too much and displace the gel that's inside the disc. And that often will not hurt. And there's a lot of studies to show in pain free subjects, they get MRIs, a lot of them have disc bulges, maybe more than half, depending on the older you are, the more time you have to kind of build up wear

and tear on the disc. But really, when you look at these pain-free people, the it's their injuries haven't progressed to the point where a tissue that does have a nerve ending is being impacted. And so to answer your earlier question, disc injuries are caused by an excessive amount of bending twisting or loading and then so it's kind of like usually most of these injuries

build up over years or not decades and then before they become painful so maybe a disc bulge you might i don't know if you got an mri that you probably got an mri which show is what showed you you had a disc bulge that's usually the way most people learn of the injury. And so probably if we looked at your spine, I don't know, five years before that, there was probably already a disc bulge, but it hadn't crossed that line into, you know, pinching a nerve or irritating a nearby ligament that does have nerve endings to it. Yeah. It's, it's pretty crazy how things work. So you talk about how back surgery isn't always the best option. Is there a lot of that that goes on where people go on for surgery and maybe they shouldn't, and you have different ways of, of keeping that from being their,

their last resource, you know, and coming up with something better? Yes. I mean, we, you know, we definitely take a lot of pride in helping some patients who are, have been told they need surgery and, you know, through accurate diagnosis and coaching, avoid, avoid their pain, wind it down without the need for surgery. And I would also add to that though, there are certainly conditions where you know i talked to a person last week who i at the first visit i said you definitely need a

surgery because he had a special type of disc bulge that was so big it wasn't just pushing on one nerve root it was pushing on a lot of nerves and these some of these nerves don't just affect the legs it affects the the bladder as well. Oh, wow. People can get bladder or sexual dysfunction, such as irrit. Holy crap. Correct all this function. And because those aren't spine symptoms, right? We don't think about those as being part of the back.

Then many people don't know that that type of patient who has that much compression, there's no exercise they should do. There's no special postural thing aside from avoiding pain. They need decompressive surgery and sometimes stat. Wow. Wow, that's crazy how it can affect other things. You talk about spinal injections. Are those effective?

The standard spinal injections, which involves a numbing agent and steroids, are usually not that effective long-term. And so some of the scientific articles about it, let's say to be specific, a steroid injection, that's often referred to as an epidural for a sciatica, it tends to not fix back pain long-term. And it's usually associated with only a small reduction in pain, like a very small reduction for a short period of time. That said,

though, we definitely see these patients who they get these impressive reactions, but they're few and far between. And we don't get to see too many of them. But I, we do encounter patients where they say if I get an epidural, I have virtually no pain for six months or a year. And so what some doctors do is they use the injection to figure out the diagnosis in part. They say, well, we're targeting this nerve root and most of your pain goes away. That gives us confidence that should you need surgery at that particular level, that hopefully it will resolve the problem as well. There you go. I get an epidural before every show. It doesn't help with my back pain. surgery at that particular level that hopefully it will resolve the problem as well. There you go. I get an epidural before every show. It doesn't help with my back pain. It just feels really good or it doesn't feel really, I don't know which. That would be painful. I've

heard they're not fun to start with. I mean, they're jamming a needle up your spinal cord. So I don't know. That's Fridays around here uh let's see uh how does exercise help lower back pain should people start exercising more to i don't know get their body to regrow stuff well people should generally move more sit less have a more active lifestyle and most people with back pain there are exercises they should do that can help them heal. And then exercise is a tool. So it depends on what your deficiency is. So let's say I'm very deconditioned.

I have no endurance. My muscles are kind of not supporting me well. So maybe a patient like that might benefit from plank style exercises that are going to improve their endurance, allow them to sit and move better, and also stiffen up the muscle along the way. So if you have a stiffer core muscles around your spine, that's also helping hold your spine in place as well. And so that's one of the common mechanisms. A lot of the exercises, the idea is to move well. So a lot of, so if you choose the right exercises and then those exercises are teaching your body how to move more efficiently to use the right muscle groups, it's that can have a big impact as well. There you go. So final thoughts, what,

what have we talked about on the back that you'd like to share with listeners and then give us a pitch for your book and your services. I appreciate that. I would say for most back pain, a precise diagnosis, knowing the problem can give you a roadmap to get out of it. And in the medical field, there's this idea of non-specific low back pain, which is the idea that you have a physical injury, we don't know

exactly what's causing it. So I would say in specific spine, what we describe is there actually is a way to figure it out based on clinical diagnosis that allows you to figure out, you know, the problem in, you know, virtually every case. And yeah, I would encourage anyone who wants to learn more to, to read specific spine or check out the articles that I have a few blog articles on masterymedical.com. There you go. And I guess they can always reach out to you on your website, et cetera, et cetera. Yes. There you go. Give me that.com one more time.

It's masterymedical.com. There you go. Well, thank you very much, Dr. Jim, for coming to the show. We really appreciate it. We've learned a lot, and there you go. Well, I agree. Let me read this. I agree.

Movement is the best therapy with nerve damage. Some exercise can be a challenge because they may cause flare-ups that's coming in from linkedin with kelly thanks kelly for the input there what do you think about that thought that's absolutely right if you do the wrong exercise for your injury then let's say here's some common injuries that are common exercises or stretches that hurt nerve pain one of them is stretching. So if you, for example, try to, a lot of people feel discomfort with sciatica in their hamstrings.

So they say, oh, I'm going to stretch that out. I'm going to do this or that hamstring stretch. I'm going to do knees to chest. That often makes the problem worse because you're bending the disc more, you're stretching the nerves more. And an injured nerve, it doesn't like to be stretched. And an injured disc, it usually doesn't like to be bent and twisted or otherwise contorted and overloaded. So I think that comment was absolutely astute. And I would

say more important than even doing the right exercises is not doing the wrong exercises. That's going to break you down a lot faster. and anyone who's doing a kind of like a cookie cutter sheet of oh these are the disc exercises without receiving that original kind of assessment to figure out what the pain triggers are you often say oh this person gets hurt by a b and c and then you'll see exercises that cause a b and c to occur so that's when you know there's a mismatch and it's not surprising that they're not responding or worsening there you go well it's good we had you on the show then dr jim thank you very much for your insights hey thanks for having me chris thank you and thanks to our audience for tuning in take care

of your back it's the only one you got last I checked, they don't make replaceable parts. You know, you can't order one from GM and be like, hey, put in a new one. They're working on that bionic spine for Wolverine or something. Yeah, what was going on? That was like the bionic man was like in the 70s. And they're like, yeah, everyone's going to have bionic parts here in the future. And I'm still waiting on them. I'll take it, I got a few parts that need some replacement.

Usually this thing, the old noggin needs a replacement there in the old brain. But everybody knows that. Thanks for tuning in. Go to goodreads.com for just Christmas. Order up the book wherever fine books are sold. That's always important. And hey, it's almost Christmas, so

remember, stock up on books. Give them away to all your loved ones and stuff. Make them smarter. Make them so that they have something to read so that maybe they'll talk to you less over Christmas dinner. There you go. That's an idea. Specific Spine, a doctor's guide to back pain relief written for clinicians, therapists, trainers, and ordinary people with back pain. We have a lot of workout and exercise coaches that come on the show, so this would be helpful to them as well.

Thanks so much for tuning in. Be good to each other. Stay safe, and we'll see you guys next time. Now, shove us out.