75. Dr. Grant Elliott: Still in Pain After the MRI, Meds, and PT? This Is How You Actually Fix Your Back

Back pain is one of the most common health issues—but it's also one of the most misunderstood. In this episode of Extend, I'm joined by Dr. Grant Elliott, a physical therapist and founder of RehabFix, to unpack the real reasons people stay stuck in chronic pain and what it actually takes to recover. We break down why most diagnoses like sciatica or disc herniation are misleading, why MRIs often make things worse, and how the brain and body respond to fear-based treatment approaches. Dr. Elliott shares the daily habits and mindset shifts that move the needle most, plus how to bulletproof your spine with simple strength and mobility practices. We also dive into the problem with gabapentin and pain meds, how to get back to exercise safely, and what most people miss when trying to heal holistically. Dr. Grant Elliott is a physical therapist, creator of RehabFix, and expert in conservative, movement-based solutions for back pain. He's helped thousands avoid surgery and reclaim their mobility through education, strength, and smarter recovery protocols. We also discuss: Your MRI says "herniated disc"—but you feel fine? How MRIs can make back pain worse Why movement is medicine for your spine 97% of disc herniations heal on their own The nervous system: the hidden driver of pain Weird symptoms? Your spine might be the reason (even ED) Thank You to Our Sponsors: Timeline: Upgrade your energy from within! MitoPure by Timeline helps power up your cells, supporting muscle strength, mental clarity, and overall vitality. Stay active, sharp, and strong at any age! Deliverance: Give your liver the care it deserves! Deliverance is a powerful plant-based formula designed to support and restore liver health. Get 10% off your first order with code DRSHAH at loveyourliver.com https://loveyourliver.com Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/ Learn more about Dr. Grant Elliott: Instagram: https://www.instagram.com/rehabfix/ Website: https://www.therehabfix.com/ Facebook: https://www.facebook.com/jimkwikofficial/https://web.facebook.com/grant.elliott.39?_rdc=1&_rdr# https://web.facebook.com/grant.elliott.39?_rdc=1&_rdr YouTube: https://www.youtube.com/@JimKwikhttps://www.youtube.com/channel/UCEIuFir2D63x9a1FWWEGqZw

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world renowned experts, offering you a step by step guide to proactively avoid disease and most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  Dr. Elliott, you flew all the way out here from Tampa to see me. I'm so excited that you're here. Thank you for joining the Extend podcast, man.

• 0:56Speaker 01

  Absolutely. Well worth it already. I love the introduction and just your hospitality.

• 1:00Dr. Darshan Shah?

  I love it. I love it. So what was really cool for the listeners is that right before we started this podcast, I had one of my favorite people here, Sean Stevenson, and he was experiencing some sciatica and he happened to run into you in between podcasts and you actually put him through some motions and some exercises and some tests to help him. And that was exactly the topic of my conversation with you today. So it was so fortuitous.

• 1:25Speaker 01

  Perfect. Yeah, that starts the line for sure.

• 1:28Dr. Darshan Shah?

  I know. And so for the listeners who don't know, Dr. Grant Elliott, you're probably more well-known as the Rehab Fix guy, right? That's where I found you. You have an Instagram channel called Rehab Fix and I've referred a lot of patients to that channel that come in with lower back pain and then they've taken your online courses as well, right? Which I haven't taken one yet, but I'm sure one day, well, hopefully I don't need to, but maybe one day I will, you know?

• 1:55Speaker 01

  Yeah.

• 1:55Dr. Darshan Shah?

  Yeah. And so with that, I'd love to hear a little bit about your background. How did you get into back pain?

• 2:02Speaker 01

  Because I had back pain. Ah. And here's where the story is going to get kind of fun is a lot of people, and you probably had similar through your, through your medical program that, hey, you know, what got you into medicine, whatever form of medicine that might be. Most of the time, people say they had some success story, some, hey, I experienced this and someone helped me and inspired me to do that. And mine is the opposite. Mine is, I was into mountain bike racing. This was through high school and I was highly competitive and I was good and I was getting scholarship offers. Wow. And my races started getting to the point where it was hour and a half, two hours of high effort the whole time, a lot of flexion with force, and I started getting back pain. And it kind of kept increasing, kept increasing, you know, wasn't going away. And I'm like, you know, 16, 17, I'm young.

• 2:46Speaker 01

  And at one point, I really started affecting my races, like, okay, this is actually becoming an issue that isn't going away. So my dad said, all right, we should go see a chiropractor. So I went to a chiropractor and what I, what I know now was at the time, I'd say a more traditional, old school chiropractor is what I would say. The, you know, x-rays first, spine's crooked, you know, adjust three times a week and we'll change your life type thing, which hey, for some people that is helpful and that's awesome. But for me, I mean, I did that for a few months, going there like three times a week and there was really no change and my pain kept getting worse and I stopped racing. I bailed out, like literally quit my racing career at that time. Yeah. So I just got into working out because I needed an athletic outlet.

• 3:28Speaker 01

  I was at the gym one day and I saw this gentleman there and he was performing some like, you know, warm-up movements and mobility movements. And I was like, this is different, you know, this is kind of interesting. Approached him, started talking to him. He said, he's a chiropractor. I thought I knew what chiropractors were, what my association was. And he started talking about how, how he works and I was like, this sounds very different than my experience. So I went and shadowed him. Yep. Saw him doing rehab, you know, soft tissue work with people and I was like, okay, this is completely different than my experience was. And if I had experienced this, I probably would have kept racing. Yeah. So that's what inspired me to be one of the good guys and to be as good as I could and go and be a chiropractor so that I could prevent stories like mine from occurring to other people.

• 4:13Dr. Darshan Shah?

  Right, right. And you know, for people who are watching this podcast, I can tell you're a weightlifter by looking at you. So one of the things I want to focus in on is how does one protect their back when they're in the gym and weightlifting? But before I get onto that, I want to talk about just a subject in back pain in general. So when do people usually come to see you? Like, what kind of symptoms are they having? What has happened? What's usually kind of the patient presentation that you see?

• 4:37Speaker 01

  Yeah, so all of our, you know, exercises, media, everything is specifically low back pain, and then it will lean towards disc herniation and sattica-like symptoms. So because I post things related to exercise in my own life, leaning towards exercise, the most common individual who comes to us is someone who isn't able to exercise to the degree that they want to, or participate in any form of activity that they would otherwise be preferring to do. So that's being taken away from them. They have low back pain, and the most common presentation we see is flexion-tolerant back pain, where usually what they're saying to us is, hey, sitting for long periods, oh, it's the worst. Long car rides, first thing in the morning, bending over to put socks and shoes on, oh, no way. And especially

• 5:20Speaker 01

  if there's someone with any form of referral into the leg, that's going to be extending the leg, stretching the hamstring, tight pulling sensation, and that just feels awful.

• 5:30Dr. Darshan Shah?

  Right.

• 5:30Speaker 01

  That is the most common presentation, usually anywhere between late twenties to early forties is the candidate that comes to us. And their mission is to avoid injections, avoid surgery, to actually get the right movements for their condition, and to get back to being fit.

• 5:45Dr. Darshan Shah?

  Got it. And so when people come and see you, have they hurt themselves acutely? Or is it something that's developed over time?

• 5:52Speaker 01

  Great question. So also, the evidence supports our own anecdotal experience, which is most of the time, it's insidious in nature.

• 5:59Dr. Darshan Shah?

  Right.

• 5:59Speaker 01

  Low back pain is insidious. There, yes, there are instances where someone will join our program, get on a call with us, and it's, hey, I was deadlifting last week, felt a pop, could barely stand up the next day, and now I'm here. Does that happen? Of course. We have around 200 consultations a week. So of course, we hear that.

• 6:16Dr. Darshan Shah?

  Right.

• 6:16Speaker 01

  But the vast majority, and the evidence supports this too, is, hey, you know what? I'm active, and I might feel things here and there, but I kind of just Woke up one day and just kind of noticed my back was stiff and a few weeks went by and it didn't really change and then a few weeks by it just kind of got worse and a few weeks went by and now it's really starting to impact me and it's not really going away now. That is the most common scenario.

• 6:37Dr. Darshan Shah?

  Yeah, yeah. And so, you know, that's kind of my experience too. Most people that come to me and say, you know, I've been having back pain and they describe this as part of their entire symptomatology when we're bringing them into next health, but usually that's like the number one problem in their life is their back pain, you know? But it came on insidiously, like you say, it's something that is really affecting their life more than anything else is and they're looking for a solution. And so, before we get into solutions, I want to ask you as well, like, what is actually going on anatomically in the back that you mentioned, like, some people are lifting weights or they go down, they bend down incorrectly, they lift something and they feel a pop, right? What's actually happened there in the back?

• 7:17Speaker 01

  So, in that sort of context, feeling a pop and then immediate, if not shortly after onset of symptoms, followed by, you know, difficulty standing up straight, very stiff next day, that's a very classic disc herniation, disc bulge scenario where, you know, the pop is, one could be joints going past their periphanological, you know, ability, but also the actual, the disc protruding through the annulus itself or bulging into the annulus layer. So that would be the most common association with, it's not actually, you know, popping like that, but the feeling or the sensation of that.

• 7:49Dr. Darshan Shah?

  Right. So like when you describe the anatomy of that, basically you have the bony segments of the spine and go ahead.

• 7:54Speaker 01

  Yeah, sure. So bony segments of the spine and, you know, there's intervertebral discs that are between each one. There's an inner gel-like substance called the nucleus populus and then the outer tough fibrous layer called the annulus fibrosis. And a disc bulge or herniation occurs when the inner layer is either pushing into the outer layer and creating a bulge or actually piercing through that layer and creating a larger bulge to eventually some of, something like a sequestration where it's actually leaking out into the, into the, into the canal.

• 8:24Dr. Darshan Shah?

  Got it. And how does that lead to leg pain?

• 8:26Speaker 01

  Yeah. If something is protruding enough to impact the exiting nerve root, then that can elicit symptoms down the sadoch nerve. And then they can experience symptoms anywhere that sadoch nerve innervates. And generally speaking, the sadoch nerve innervates the whole backside of the leg, even to the, to the front of your toes. So we've had some clients where they're like, you know what? I have some back pain, but it kind of went away. But I have, you know, a few toes are numb. And so I'm seeing a, you know, podiatrist, I'm doing acupuncture on my foot and it's not really changing anything. I'm like, oh, that's a back issue. Like, well, my back doesn't really hurt anymore. That's, that's a back issue. So anywhere through the leg could be a symptom of the back.

• 9:06Dr. Darshan Shah?

  Got it. And with this back pain sciatica scenario, are there other symptoms that they might feel as well?

• 9:12Speaker 01

  Certainly. There's a wide array to hit a massive spectrum. I already mentioned some of the mechanical components of the back itself. But a lot of individuals can have, yeah, numbness or weakness into the foot, lack of sensation. But there can definitely be pelvic floor pain too. There can be increased pain with coughing, sneezing, bearing down. Most recently, just in the last month, we've actually had a lot of males with unilateral testicular pain on the same side of symptoms. This is actually way more common than, than a lot of people realize. In the topic of the groin region, there could also be effects such as erectile dysfunction. We've had a, we had a client in Italy, true story, had a client in Italy, hurt his back, very minor injury, very minor injury, just flat up for a couple of days.

• 9:55Speaker 01

  Shortly after, wasn't able to achieve an erection. And this went on for months. Reached out to us because I made a video about testicular pain, erectile dysfunction, pain with orgasm in regards to low back issues. Reached out to us, he had absolutely no pain for months. We took him through our same low back process. Erections returned and he was, you know, doing hormone treatment and seeing all these different endocrinologists for this and urologists and everyone. And, and I was like, I, I think this is, I think it's coming from your back.

• 10:26Dr. Darshan Shah?

  Wow.

• 10:27Speaker 01

  So there can be interesting symptoms in that realm too.

• 10:30Dr. Darshan Shah?

  Yeah. Yeah. So it's so important to talk about that, I feel, because I think a lot of people. Experienced groin pain, definitely, and some pelvic fore pain. And usually the back, it takes a year or longer for anyone to even think about the back and do a workup on the back. And so I've seen that a few times as well. And it's, I think it's an important thing to kind of bring to the forefront of people's attention. The back, there's a lot going on in the back. The nerves in the back end up innervating a lot of muscles, and a lot of those muscles can create different symptoms, up to and including erectile dysfunction.

• 11:01Speaker 01

  Yep. Oh yeah, way more common than, than people truly realize. Way more common.

• 11:06Dr. Darshan Shah?

  Yeah, it's crazy. All right, so that's kind of like the acute scenario that is sometimes a presentation. What's happening when someone like insidiously develops back pain?

• 11:15Speaker 01

  So that answer, once again, referring back to the evidence, we know that 90% of low back cases is deemed nonspecific low back pain. So that would be a combination of joints, muscle, and disc pain. So in that scenario, it would, I wouldn't be able to claim one specific thing is causing their pain. It's a combination of those tissues, but also a combination of the psychosocial model that goes with it, meaning other factors in their life that could be influencing that pain experience as well. It's a combination of all those things. It is multifactorial, and there's variables and layers to this, and you want to peel back the most important layers first and work through ideally all of them if you're able to.

• 11:55Dr. Darshan Shah?

  Yeah, and that's kind of what we discussed with Sean a little few minutes ago, is how those factors kind of come together. And I think the psychosomatic approach is a big, or psychosomatic reasons are also a big component for some of this insidious back pain, right?

• 12:07Speaker 01

  For sure.

• 12:08Dr. Darshan Shah?

  Yeah.

• 12:09Speaker 01

  Stress and anxiety, big, big aspects, yeah.

• 12:10Dr. Darshan Shah?

  Big aspects of it. And like we said, it's kind of like the opposite of the placebo effect. We know the placebo effect is a huge effect on people, up to 20%. The psychosomatic effect on pain is also probably 20% or even

• 12:21Speaker 01

  More.

• 12:22Dr. Darshan Shah?

  A bigger part of it, right?

• 12:23Speaker 01

  I'd say more, yeah.

• 12:24Dr. Darshan Shah?

  Yeah, and by, can you define psychosomatic a little bit? Like, what does that really mean?

• 12:27Speaker 01

  Yeah, so just any aspects of stress, trauma, worry, anything that's psycho-related, manifesting in physical symptoms. So somatic, meaning body, physical manifestations of, you know, mental-related stress and anxiety and things of that nature.

• 12:43Dr. Darshan Shah?

  Right. And you know, like, I think it's also important for people to realize that because you have a psychosomatic component to your back pain, or any pain, doesn't mean that something wrong with you, or something wrong with your brain. It's just a normal piece of this problem.

• 12:58Speaker 01

  I was just gonna say, something that is very poorly articulated in majority of the medical system is when doctors come across telling patients, "Oh, this is all in your head."

• 13:09Dr. Darshan Shah?

  Yeah.

• 13:09Speaker 01

  And a lot of people feel that way. And that's either because the provider is not doing a good job with the narrative or the messaging behind this, or because the patient could be misinterpreting it in certain components. So, the point here, and I'm so happy you brought this up, is it's not in your head, but at the same time, all pain is created in your brain, right? Your brain interprets information to decide if you feel pain or not. So, you know, we're not implying that, you know, the pain is in your head. It's not a matter of if there's a psychosomatic component, it's just a matter of how much. So, some people will be more susceptible to that than others, but there's gonna be a component in everyone. Some people will just have greater than others.

• 13:50Dr. Darshan Shah?

  Yeah, exactly. And I think it's important to address that kind of upfront, because the sooner a patient starts assessing their psychosomatic component and dealing with it in various different ways, whether it be, you know, relaxation techniques, or cognitive behavioral therapy, or just even seeing a therapist, the sooner they'll be addressing their pain issues as well, and lowering, decreasing the amount of pain. You probably have seen a lot of patients that have become addicted to painkillers and pain medications and muscle relaxers and things like that. And

• 14:19Speaker 01

  Oh, yeah.

• 14:19Dr. Darshan Shah?

  Obviously, this, we've gone through decades of overuse of this, right? And so, when someone gets put on painkillers for an acute pain issue, how long do you, do you aim for them to kind of be on those but start weaning off? What's, what are your general thoughts around that?

• 14:38Speaker 01

  Yeah, so one delicate subject matter.

• 14:41Dr. Darshan Shah?

  Yeah.

• 14:41Speaker 01

  Someone can absolutely have withdrawal symptoms.

• 14:44Dr. Darshan Shah?

  True.

• 14:44Speaker 01

  That can increase their pain. And we have had people with back pain who were taking painkillers, who were feeling okay. And as soon as they started to get off, oh, my gosh, my back pain is getting worse. You know, this program or the exercises you're giving me are not working. And it's, it's the opposite. It's you getting off, you know, your ability to get off of them because of our help is spiking your, your symptoms again. So most of the time, we don't have a lot of people that come to us who are on a consistent amount of painkillers. That's less common than the individual who's on gabapin.

• 15:15Dr. Darshan Shah?

  Wow, yeah.

• 15:16Speaker 01

  Yeah, gabapin for very prolonged use. But the manner in which we need to get them off is the same, though, is it needs to be a weaning process. Now, I don't have a, you know, clinical evidence-based criteria for the method to do that. This is purely anecdotal and general for the most part. But as soon as someone joins our program, let's say they're taking a consistent amount of gabapin, we do not recommend they just get off of it. We do not recommend that at all, even if their goal is to get off of it as quickly as possible. We don't recommend that. We want to address one very blooded time. So we recommend they stay on the amount that they've been for at least one to two weeks so that we can know what the exercises we're implementing and what movements, what the result of those are. And if while they're on that medication, and we can assume it's painkillers too, if

• 15:58Speaker 01

  we're seeing decreased symptoms, improvements in range of motion, decreased sciatica, then we can be confident saying, okay, we know the path we're on is the right direction. And then we will tell them, all right, let's take whatever amount they're on, let's, let's cut, you know, 20%.

• 16:11Dr. Darshan Shah?

  Right.

• 16:12Speaker 01

  Let's just take 20%. And we'll warn them, when you do this, you might notice an increase in symptoms. But don't let that, you know, blur your judgment because we already have data right now that your symptoms are going in the right direction. So the only variable that's going to change is the amount of medication you're taking, not the exercises you're doing. So we prepare them for that. And we basically just chip away 20% ideally, um, you know, at that point, every week or every other week, we try to chip away 20% until ultimately there's, there's nothing.

• 16:40Dr. Darshan Shah?

  I love that protocol because it involves the patient, there's clear communication on how we're going to do this, a little bit at a time. Based on their symptom reduction, fantastic way of doing it. I think everyone that's on gabapentin or chronic pain medications needs to work with someone who's going to be implementing some sort of pain medication reduction protocol over time, right?

• 17:02Speaker 01

  Oh, yeah.

• 17:02Dr. Darshan Shah?

  Yeah, so I would just say to the people listening that if you're having low back pain that is not debilitating and not acute, it's kind of insidious in origin, to seek out someone who's going to help you with a rehab before you start pain medications. Would that be a fair statement?

• 17:18Speaker 01

  Yeah, so vast majority of low back pain is a movement-based problem.

• 17:21Dr. Darshan Shah?

  Right.

• 17:22Speaker 01

  And it needs a movement-based solution. So the frontline defense of all back pain should be lifestyle modifications and a movement-based plan. Even if it's simple, let's say they see a provider and the provider does not feel well-equipped in this arena, okay? Even if that provider just says, hey, how about you just try walking more for the next couple of weeks? Check back, and if you're still not better, or even in addition, I'm going to refer you to someone who is a movement-based specialist. Like even just telling someone to walk more could have a drastic impact on their back pain and on their lifestyle as a whole.

• 17:53Dr. Darshan Shah?

  For sure, for sure. I mean, it's such a, such a basic thing that we just forget as part of the treatment algorithm. You know, it's, it's just mind-blowing. Yeah, and before, people didn't have access to doctors and they didn't have access to pain medications. That's what they would do. They would be told to just walk more.

• 18:09Speaker 01

  Yep.

• 18:09Dr. Darshan Shah?

  Stretch more, those kind of things, right?

• 18:11Speaker 01

  Yep.

• 18:11Dr. Darshan Shah?

  Yeah, it's just, it's incredible what we've come to just the ease and the, the ease of just prescribing a pain medication and getting it and just starting that. And it's really, like I said, two steps backwards before you take a step forward.

• 18:28Dr. Darshan Shah?

  At my practice at Nex Health, I'm often amazed by how many of my patients have liver health issues. It turns out that 38% of Americans have fatty liver disease, and most people have no idea. You wouldn't really know until you do something like a liver scan using ultrasound shearwave technology, which we offer to all of our patients at Nex Health to get a good idea of how much damage has been done from metabolic disease and alcohol consumption. This is where a new product called Deliverance comes in. Invented by Siggi Clavion, it uses natural plant extracts that you drink as a liquid shot, which have been shown in studies to prevent and reverse fatty liver disease. I personally have a history of metabolic disease, which I work really hard to keep at bay.

• 19:10Dr. Darshan Shah?

  I use Deliverance myself three times a day to prophylactically make sure that my liver stays healthy. It's super easy to use and actually tastes good, too. You can save 10% on your first order when you use the code DRSHAH, that's D R S H A H, at the website loveyourliver.com.

• 19:35Dr. Darshan Shah?

  So I'm 52 right now, but I'm still pushing all of my limits. I'm running long distances. I travel across many time zones to support my work, and I just want to live my life to the fullest. Staying active as I age isn't just about willpower. It's about supporting my mitochondria, the powerhouses of my cells, with the energy that they need to recharge my muscles and recharge my brain. Mitopure is a supplement that I take. It's backed by solid research, showing that it can boost cellular energy, increase muscle strength, and support overall healthy aging. Personally, I take Mitopure every single day. This has helped me continue my active lifestyle, whether it's a high-intensity workout or keeping up with my kids.

• 20:18Dr. Darshan Shah?

  So if you are looking to support your body and want to feel younger from the inside out, my friends at Timeline are offering you a 10% discount on your first order. Go to timeline.com/DrShah to get started. That's timeline.com/DRSHAH. Your future self will thank you.

• 20:39Dr. Darshan Shah?

  Everything's been skipped in between, right? Like, before there was surgery for back pain, there was a lot of things that people did for the back pain, right? Yeah. So that's what we're here, what we're going to talk about today. And I want the audience to know that, you know, if you have not seen someone in your field, like rehab, before you see a surgeon, you're missing part of the boat there, right? The big part of the boat. Surgery's not the Primary answer a cure to back pain.

• 21:04Speaker 01

  Yeah, this one statistic alone will prove that. So in 2020, there's a massive study. Two hundred and eighty thousand people with lumbar disc herniation and ninety seven percent resolved without surgery.

• 21:16Dr. Darshan Shah?

  Wow.

• 21:16Speaker 01

  So statistically, about three percent of people with lumbar disc herniations who are symptomatic will require surgery. But you tell me, you think only three percent of people are getting surgery? No, way more than that. So conservative therapy to any capacity is the primary treatment.

• 21:35Dr. Darshan Shah?

  Sure.

• 21:35Speaker 01

  Of low back pain. We know that education and exercise is the number one treatment. It is the number one treatment for musculoskeletal pain in general, but especially low back pain. And literally, the number one treatment is being leapfrogged to go straight towards medical interventions following the biomedical model. Oh, in order to help, we need to see what the problem is and then treat what we see.

• 21:56Dr. Darshan Shah?

  Right.

• 21:56Speaker 01

  It's a huge mistake in the healthcare system.

• 22:00Dr. Darshan Shah?

  Yeah, and just the algorithm has been completely become, like you said, the medical care. So the Western medical system, which is imaging to diagnose a disease or lab work to diagnose a disease. There's now we have a diagnosis and the treatment is a surgery or a pill.

• 22:14Speaker 01

  Yeah.

• 22:15Dr. Darshan Shah?

  Right? And it's, that's the whole purpose of this podcast is to tell people there's much more than the typical Western medical system. That's being missed right now. So I'm glad you're here talking about this, but I think it's important for people to know too. Like when they hear that they have a disc herniation, for example, how does that heal itself? Like, once a disc is out, how does it actually go back into where it's supposed to be?

• 22:38Speaker 01

  So first is, it doesn't have to.

• 22:41Dr. Darshan Shah?

  Right.

• 22:42Speaker 01

  A disc doesn't have to fully regress or resorb for someone to become pain free and live a totally normal life and be fully functional.

• 22:50Dr. Darshan Shah?

  Interesting.

• 22:50Speaker 01

  So, and this is also a component of why imaging has changed the narrative is because people are dictating outcomes by imaging. So, hey, if there's still a disc bulge on an image, that means you're not healed. And so a person will believe if I still see something on my image, then I'm not healed. And now there's this understanding that it has to be gone in order for them to, quote, be healed. But then you have to ask yourself, what does? Healed mean to you? Does healed mean this is on a picture? Or does healed mean you're paying for it and you can live your life and do whatever you want? So the two different outcomes are, one, yes, disc herniations to high degree can absolutely resorb and sometimes totally naturally and spontaneously, typically within nine to 12 months.

• 23:31Speaker 01

  And the statistics show that the greater the herniation, the higher the chance of spontaneous resorption. So bulges is lowest chance of it resorbing on its own. Sequestration is significantly higher. I think it's around 70%, but I would have to look. Don't directly quote me on that, but there's a great study that that looked at this. So yes, it can resorb, but then the second aspect is it does not have to. It does not have to. So it could remain, but it could have resorbed just enough or moved just enough through treatment that it's no longer symptomatic, that active site, the inflammatory chemical mediators that are active there are no longer active. It almost forms, if you will, a callus of the spine and it's no longer causing a problem.

• 24:15Dr. Darshan Shah?

  Got it, got it. And is there also a certain component of just the inflammation goes down? And that also creates some pain relief by not compressing on the surrounding nerve structures?

• 24:23Speaker 01

  Yep, absolutely. And the inflammation, this is also why medication can be negative in this component, is the inflammation is what helps kickstart the resorption process. So if you have a disc herniation, let's say, and let's say it is acute, if you immediately get injection or steroid pack, which when it's indicated, it's indicated. And we do advise people to get steroid packs and injections when indicated. But if you get these things immediately without indication, then you're shunting the body's focus on how to resorb that naturally, because it doesn't have the same signaling it normally would otherwise. But yes, the inflammation of that site can then, you know, leak over to the nerve root and that could create symptoms on the leg, not necessarily directly impacting, but just having increased inflammation in the area.

• 25:08Dr. Darshan Shah?

  Right, right. But also like with time too, the inflammation will resolve and there'll be less inflammation. And so time is also a big.

• 25:16Speaker 01

  As a healer.

• 25:17Dr. Darshan Shah?

  Healer, right. And I think a lot of people jump straight to injecting their spine. And like you said, steroid packs. I want to talk about one more thing, which is how does someone in modern society, which, you know, I define as mostly sedentary now, sitting eight hours a day at work and then going home in a one-hour cow ride sometimes, and then sitting in dinner and then, you know, laying down at night. How does a person prevent getting into this situation in the first place?

• 25:43Speaker 01

  Movement snacks. We deem it movement snacks. So when you phrase it like that, which you're absolutely correct. They, they wake up and they sit at the table for breakfast. They sit in the car to drive. Then they sit at work. And then they sit watching TV at home and they sit at dinner. That's a whole lot of sitting. Oh, my gosh. How could I ever overcome that much sitting? Well, here's a huge piece of encouragement that just by having regular movement breaks throughout your day, or by having, you know, at least, I'm forgetting the evidence here, but I think it was around maybe 40 minutes, a 40-minute bout of exercise can essentially undo all of that. Like eight hours of sitting can basically be undone with like 40 minutes of exercise. Something along those lines. It's not going to be perfect.

• 26:26Speaker 01

  So one cool study showed, they were doing MRI evaluations of individuals who had sedentary lives. And then what they did with one group is they looked at, okay, what's the size of your disc at the start of the day? What's the size of your disc at the end of the day? So one group did that and had no movement education and just sat at work all day. And they, they found a significant decrease in disc height. Now, we, we both know overnight that will resorb as it's supposed to through inhibition. But in the group that they provided intervention in, what they said was they wanted them to do a 20-second movement break every 15 minutes. And this 20-second movement break was just simply standing up, bending forward for five seconds, bending backward for five seconds, bending to the right and left for five seconds. That was it.

• 27:09Speaker 01

  And then when they did their pre and post MRI before and after at the end of the day, which once again, I don't really recommend this, you know, the value in progress through MRIs, but there was almost no reduction at all of disc height.

• 27:20Dr. Darshan Shah?

  Yeah.

• 27:20Speaker 01

  So we knew that movement in general is good for health of joints and tissues of the spine. So for anyone who has a sitting sedentary based lifestyle, all you need to do is implement some form of movement snacks, movement breaks throughout the day. And that could be as simple as going on a walk at the top of every hours. Walk around your office or walk around your building or getting into the break room and just doing literally one minute of movement could make a significant difference in your longevity in that workplace throughout the day or throughout your life in general. So just simple movement breaks.

• 27:57Dr. Darshan Shah?

  So true. I love this topic of movement snacks. I talk about it. I feel like in every podcast I'm on.

• 28:03Dr. Darshan Shah?

  The research I saw was somewhere between every forty five minutes, every thirty to forty five minutes of work, so I use forty five as my number, to take a three to five minute break. And so what I actually do on my own desk, and I buy this for a lot of my patients and people that I work with, is an egg timer. And I just have them set it to forty five. And then I have them pick three or four different things that they can do to mix it up. Sometimes squats are great. I want to add this, like bend forward, bend backwards, do some jumping jacks. Not only does it help unload your back, but it also helps keep your VO2 max at a, at a stable level. So people that don't move throughout the day, their VO2 max continually declines. However, the people that have five minute breaks every forty five minutes

• 28:48Dr. Darshan Shah?

  will actually maintain a VO2 max level without exercising, without any extra time at the gym. And that's really powerful because we know that VO2 max is such a significant predictor of longevity. And so I think this movement snacks, it's like a magical key to solving a lot of problems for a sedentary lifestyle, right?

• 29:08Speaker 01

  Oh, yeah.

• 29:08Dr. Darshan Shah?

  Yeah. And you know, you think about just gravity, like applying four hours of gravity on your spine. That's a lot of, that's a lot of compression to your spine, right? And so just unloading that gravity, even just for a few minutes, allowing the fluid to come back in, allowing everything to just realign itself, even just for five minutes can just reset that whole process.

• 29:29Speaker 01

  Yeah, totally. Yeah, it's like you're rewinding four hours.

• 29:32Dr. Darshan Shah?

  Exactly.

• 29:33Speaker 01

  Three to four minutes of movement.

• 29:35Dr. Darshan Shah?

  So you know, right before this podcast, you happened to run into Sean Stevenson, who was experiencing sciatica, and you put him through some evaluation movements. Can you talk a little bit about those and what those kind of mean to you just globally? And then what I'm going to do is I'm going to post the video we took of that at the end of this podcast, so people can actually get a real practical example of kind of your process with patients.

• 29:58Speaker 01

  Yeah, perfect. So what I took him through was initially some global range of motion of his spine. So bending forward, bending backwards, and rotating, just global ranges of motion. Because we're looking for overall restrictions of the spine, but also what triggers their symptoms. That's really what I care about the most. So we obviously have a pattern and a protocol for low back pain, disc herniation, and sciatica. And so what I'm looking for is, of the typical boxes that we see someone will check, how many of these boxes are being checked for someone that I know we can absolutely nail it with and get them out of pain? And so I'm looking for patterns. I'm looking for patterns and behaviors of typical scenarios. So not only does this inform us of, okay, this is a very common scenario that we can

• 30:43Speaker 01

  help, that's one component, but it also helps us have benchmarks for tracking progress over time. So if I take someone through forward flexion, there's two things I want to know is, one, how far can you go? Are you restricted? And does this trigger your symptoms? But also, at what point do you feel those symptoms? Let's take a picture, let's freeze that in time, let's look at that one week later, and let's see how you're progressing. That's a great visualization for them to actually see their progress on a weekly basis, which makes it more real to them and a stronger belief in engagement in that process. So that can be very helpful for them alone. So using this as benchmarks and outcome assessment trackers as you go is huge. So I don't know if you want me to go through each test that I did.

• 31:26Dr. Darshan Shah?

  No, just globally, like you put him through some movements, there were global movements of just spine range of motion, right?

• 31:31Speaker 01

  Yep, so just spine ranges of motion to see exactly that. Where his, where his range of motions are, what's limited and what triggers. And then we did a similar thing for his hips, just assessing what is mobility, when we put tension on the rotators. Of the hip, does that increase symptoms? Cause for most individuals, that will put the sciatic nerve on stretch and that could elicit greater symptoms too. And then when we re compare, when we reevaluate after performing an intervention, if we see that at a test such as a hip crossover, all of a sudden feels looser, then we can know, okay, that tight glute is not a tight glute. That's nerve tension and that can be very helpful and informative for them to knowing, okay, this is truly a back issue. I don't need to be, I don't need to be foam rolling my glute every day.

• 32:14Dr. Darshan Shah?

  Yeah.

• 32:14Speaker 01

  So that along with nerve tension tests.

• 32:16Dr. Darshan Shah?

  Yeah. I think that's an important point that you made when you were evaluating him was that, you know, a muscle doesn't just become tight unilaterally out of nowhere. Right? Usually there's some sort of injury that's happened to the muscle. So really it's probably more likely it's coming from something in your back.

• 32:31Speaker 01

  Absolutely.

• 32:32Dr. Darshan Shah?

  Right?

• 32:32Speaker 01

  Yep.

• 32:33Dr. Darshan Shah?

  Yeah, like you said, people are foam rolling like their one glute all the time. And it's like, that's really not probably going to help a lot. Right? It's more of getting your back, doing some bath strengthening exercises and stretching and all that stuff. Right?

• 32:46Speaker 01

  Yeah, for sure. I mean, the, the classic scenario of, hey, you're addressing the symptom, you know, not the real cause.

• 32:51Dr. Darshan Shah?

  Right.

• 32:51Speaker 01

  Although it sounds really cheesy, but yeah, to your point, you should, a few alarm bells should ring if all of a sudden a muscle feels tight out of nowhere. And especially in those scenarios where it's insidious. Like if you just wake up one day and your glute's super tight or your hamstring's tight and that's not going away, was there any form of significant strain or injury to that muscle? Either through mechanical impact or in extreme exertion? If not, then it doesn't make sense for that muscle to randomly become tight. So you need to look up the chain, look centrally and see what could be creating that tightness.

• 33:21Dr. Darshan Shah?

  Right. Yep, exactly. And so just to segue a little bit, I want to talk about hip mobility a little bit because I think a lot of people have problems with hip mobility as well with their sedentary lifestyle. How does that fit into this entire picture?

• 33:32Speaker 01

  Yep. So evidence shows that hip extension specifically can have relations to movement mechanics and back pain. It's not the only thing. Another good analogy is imagine if you're wearing really tight leather pants. And then I ask you to squat down. We all know all that'd be tight, all you wouldn't be able to get in that position. You're going to move through your back way more than otherwise because the other joints, the hips primarily aren't able to do their job. So if hips are locked up, it can absolutely put more pressure on the low back due to compensation and could impact you in these ways.

• 34:09Dr. Darshan Shah?

  And so how do people keep their hips mobile?

• 34:12Speaker 01

  Movement, baby. Of course, there is some, you know, specific hip mobility movements that I really like that can help pretty much anyone, but just knowing that, almost back to the sedentary lifestyle type of thing that you said, if I'm sitting in this position all day long, what movements are my hips getting? Really just hip flexion.

• 34:32Dr. Darshan Shah?

  Exactly.

• 34:32Speaker 01

  I'm just sitting in hip flexion all day. So, an easy way to think about your movement in any joint in your body, any joint, is think, what is the position that this joint is in majority of the day? And what are the positions of the joint that it is not getting in? Let me find ways to get it in those positions more.

• 34:51Dr. Darshan Shah?

  Right.

• 34:52Speaker 01

  So, if I'm getting a lot of hip flexion, I would think, okay, if I'm in this eight hours a day, what is my hip not getting? My hip is not getting extension, it's gonna be the main one, it's not getting any extension, it's not getting any internal rotation. Sure, I might sit like this randomly, it might be getting some external rotation, but it's not getting any internal rotation. So, what I should do is I should create a routine at home that is gonna get me more hip extension and more hip internal rotation. Very simple way to analyze it. And you can do the same thing with your shoulder, too.

• 35:21Dr. Darshan Shah?

  Yeah.

• 35:21Speaker 01

  If my shoulders are in this all day, okay, I'm getting shoulder flexion, I'm not getting any shoulder extension. Let me get more shoulder extension, let me get more shoulder abduction, let me do more movements of my joint that I'm not getting enough of throughout the day.

• 35:33Dr. Darshan Shah?

  Yeah, that's what you just said in the last couple of minutes here, I think it's incredibly important for modern office workers, because modern office workers wake up at 50 years old with immobile shoulders and immobile hip joints. And it's a big part of the problem for their future longevity, because that inability to move your shoulders and move your hips leads to falls and then leads to frailty later on in life. And so, one of the exercise snacks that should be mixed into your exercise snack routine, in my opinion, is some sort of shoulder and hip mobility exercise, whether you're squatting and where you're grabbing a towel behind your shoulders. I feel like that's very helpful for the modern kind of office worker.

• 36:12Speaker 01

  Yeah, absolutely. And as an initial intervention, that's fantastic. And one thing I want to bring out is, I understand not everyone is passionate about, you know, weightlifting or bodybuilding or things like that. But a point I want to make is that if you have any form of strength training routine, any form of consistent strength training routine, the reality is that you're going to be getting your joints in all these positions that you're missing anyway, and under load to promote long-term adaptive changes. So if you're listening to this or watching this and you're trying to think, it's kind of hard for me to even know, like, what range of motions are my body missing? What positions should my hips or my shoulders be getting in?

• 36:53Speaker 01

  If you don't know, an easy answer is just go do a leg workout, go do a shoulder workout, and you're going to hit all the ranges of motion.

• 37:03Dr. Darshan Shah?

  Right.

• 37:03Speaker 01

  Like, so the benefits of just having a fitness weight training routine, too.

• 37:08Dr. Darshan Shah?

  Yeah, I think it's incredibly important, especially after the age of 40, for sure, is to make sure that's part of your exercise routine. Because you see so many 40, 50-year-olds, their workout is really just going to the gym and running on the treadmill. There's not a strength training component to it.

• 37:23Speaker 01

  Yeah.

• 37:23Dr. Darshan Shah?

  And they end up with massive mobility issues in the future.

• 37:26Speaker 01

  Yeah, no load. You gotta have load.

• 37:27Dr. Darshan Shah?

  You gotta have the load, exactly. Love it, love it. Man, this is a great conversation. We covered such a huge swath of topics.

• 37:36Speaker 01

  I know. This is awesome.

• 37:37Dr. Darshan Shah?

  But I mean, this is going to be so incredibly helpful to the thousands of men and women out there that are experiencing back pain and don't want to experience back pain in the future as well. This is so, such an important topic because it affects so many people. And I've seen people go in the wrong direction with back pain and get addicted to painkillers and to becoming immobile, getting put on disability at work, unable to work. And it really ruins their life.

• 38:03Speaker 01

  Oh, yeah.

• 38:03Dr. Darshan Shah?

  It doesn't have to be that way, right?

• 38:05Speaker 01

  Oh, yeah.

• 38:06Dr. Darshan Shah?

  Or they get surgery and injections that they never needed in the first place. So many things that people don't consider. So I'm excited to get this out there, man. Thank you so much for doing this with me.

• 38:16Speaker 01

  Well, thank you for giving me the opportunity to get it out there. I greatly appreciate it.

• 38:20Dr. Darshan Shah?

  Yeah, we already talked a little bit about where to find you, but let's just mention it one more time.

• 38:24Speaker 01

  Yeah, so we are at RehabFix. RehabFix on all platforms. Instagram is our most popular. Our YouTube is growing big time. I've gained 500,000 subscribers in just about two years now. So that's a heavy base. But on all social media, you can find us at RehabFix.

• 38:42Dr. Darshan Shah?

  Great. And what's your website?

• 38:43Speaker 01

  Website is therehabfix.com. RehabFix handle was taken by a drug and alcohol treatment program that's unwilling to sell it to me.

• 38:52Dr. Darshan Shah?

  TheRehabFix.com. Got it. Dr. Ollie, thank you so much for joining me today. Can't wait to see you again next time and have you on again to talk about even more stuff like this. This is fantastic.

• 39:06Speaker 01

  Absolutely. It's been a great conversation. Thank you for having me.

• 39:09Dr. Darshan Shah?

  Thank you. Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps us support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.