212. Dr. Brad Goodman: The Truth About Chronic Back Pain & How to Avoid Surgery

What if the solution to your chronic back pain isn't another prescription, another injection, or even major spine surgery—but identifying exactly where your pain is coming from? Back pain is one of the most common reasons people lose mobility, stop exercising, and experience a decline in their quality of life. Yet many patients spend years cycling through physical therapy, pain medications, and specialist appointments without ever getting a clear answer about what's actually causing their pain. In this episode, I'm joined by Dr. Brad Goodman, a specialist in physical medicine, rehabilitation, and minimally invasive spinal interventions at OrthoAlabama Spine & Sports, to explore why chronic back pain can be so difficult to diagnose and the emerging treatments offering new possibilities for relief. Dr. Goodman has dedicated his career to identifying the underlying sources of pain and developing targeted, minimally invasive approaches that may help patients avoid major surgery. Together, we break down the anatomy of the spine, why traditional treatments sometimes fail, and how new technologies are changing the way we approach chronic pain. In this episode, you'll learn: Why chronic lower back pain can develop years before symptoms appear How herniated discs, degenerative disc disease, pinched nerves, and spinal stenosis cause different types of back pain Why identifying the actual source of pain is critical before choosing a treatment How MRIs and other imaging techniques help doctors investigate spinal inflammation and structural problems Why walking, movement, and physical therapy are essential for maintaining mobility and preventing further decline The minimally invasive alternatives to back surgery, including epidural injections, nerve ablation, and spinal stabilization procedures How emerging technologies like ReActiv8 muscle stimulation and SPRINT peripheral nerve stimulation are being used to treat certain types of chronic pain What the research currently suggests about PRP, stem cell injections, and regenerative treatments for spinal discs Why chronic pain, muscle loss, inactivity, and frailty are closely connected to healthy aging How to find the right spine specialist and explore your treatment options before considering major surgery We also discuss the limitations of pain medications, the importance of spinal stability, and why some patients continue experiencing pain even after multiple procedures. One of the most important ideas Dr. Goodman shares is that relieving pain isn't just about feeling better—it's about restoring your ability to move. When chronic pain prevents you from exercising, maintaining muscle, and staying active, it can affect nearly every aspect of your long-term health. The goal isn't simply to manage pain. It's to identify its source, restore function, and help you maintain the mobility and independence that make a longer, healthier life possible. Because when it comes to longevity, movement is medicine—and protecting your ability to move is one of the most important investments you can make in your future. Learn more about Dr. Shah: Website: drshah.com https://drshah.com Clinic: next-health https://www.next-health.com/ Instagram: @darshanshahmd and @extend_podcast Learn more about Dr. Brad Goodman: Website: orthoalabama.com/doctors/bradly-s-goodman-md https://www.orthoalabama.com/doctors/bradly-s-goodman-md Clinic: orthoalabama.com https://www.orthoalabama.com/ YouTube: youtube.com/@doctalklive https://www.youtube.com/@doctalklive Facebook: facebook.com/doctalklivedrgoodman https://www.facebook.com/doctalklivedrgoodman Thank You To Our Sponsor! IM8 - Try IM8 with a 30 day money back guarantee! Use code DRSHAH at checkout for 10% off your first order at im8health.com/drshah https://im8health.com/drshah

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?

  My guest today is Dr. Brad Goodman, a minimally invasive spine interventionalist at Ortho Alabama Spine and Sports in Birmingham, Alabama. Dr. Goodman trained in physical medicine and rehabilitation at Emory, and also learned interventional spine techniques from leading specialists around the country. Today, we're talking about back pain, one of the most common reasons people stop feeling like themselves, and one of the least understood. As Dr. Goodman puts it, "There's no backologist, so patients often get bounced between specialties." He'll walk us through his simple three-column model of the spine, explain why disc tears can go unnoticed for years, and break down minimally invasive options like targeted injections, PRP,

• 1:31Dr. Darshan Shah?

  and newer procedures that can help many people avoid major surgery. We'll also cover the infection risks to ask about before any procedure, why pain medications aren't the answer, and why staying active is your true longevity molecule. Let's dive in with Dr. Brad Goodman.

• 1:53Dr. Darshan Shah?

  Dr. Goodman, thanks so much for joining me. It's been an absolute honor to get to know you just briefly so far, but we met at A4M last year.

• 2:02Speaker 01

  I appreciate, I appreciate you having me on. I just love what you're doing.

• 2:06Dr. Darshan Shah?

  Thank you.

• 2:07Speaker 01

  Fantastic.

• 2:08Dr. Darshan Shah?

  Thank you. And the reason that I wanted to have you on is, you know, in our brief conversation at A4M, you talked about what you do and you've dedicated your life to is helping people with pain. And I immediately told you, I have a lot of patients that come into our clinic, and part of the reasons that they are not feeling themselves or doing their best is because they're in pain. And this is especially true for both men and women. A lot of that pain is, you know, the typical things you hear about, shoulder, knees, and back, right?

• 2:37Speaker 01

  Right.

• 2:37Dr. Darshan Shah?

  But I think the back pain is the most concerning for people.

• 2:41Speaker 01

  It's a bit of a, it's a bit of a black box.

• 2:44Dr. Darshan Shah?

  That's exactly what I was going to say. It's a black box, right? The people have the least amount of understanding about why it's there, what they can do about it, all of that.

• 2:53Speaker 01

  Right. I think part of the problem is, is there's no backologist. If you have a heart attack, you go to a cardiologist.

• 2:59Dr. Darshan Shah?

  Yeah.

• 3:00Speaker 01

  If you have a stroke, you go to a neurologist. If you have an ulcer in your stomach, you go to a gastroenterologist. If you have a back attack, you can go to a neurosurgeon, an orthopedic surgeon, a family practice doctor, a chiropractor, a physical therapist, a physiatrist. So there's no, there's no backologist.

• 3:19Dr. Darshan Shah?

  Right.

• 3:19Speaker 01

  And, and so consequently, people get sort of thrown in multiple different paths.

• 3:25Dr. Darshan Shah?

  Yep.

• 3:26Speaker 01

  And there's not necessarily, they may or may not get into the right path, which is, which is unfortunate.

• 3:34Dr. Darshan Shah?

  Yeah. And for a lot of these professions, there's a little bit of that if all you have is a hammer, the whole world is a nail kind of thing, right?

• 3:42Speaker 01

  That's true too. That's true too. So there's, there's basically sort of four sort of pathways that people take in general. They can do surgery.

• 3:53Dr. Darshan Shah?

  Right.

• 3:53Speaker 01

  They can take drugs.

• 3:55Dr. Darshan Shah?

  Right.

• 3:55Speaker 01

  They can have drugs injected, and they can do physical therapy.

• 3:59Dr. Darshan Shah?

  Right.

• 4:00Speaker 01

  And within those four pathways, there's sort of a, a way that, that doctors get trained. For instance, if you're a surgeon who specializes in spine, there's a pathway. You go to medical school, you do a residency in orthopedic surgery, and then there's a fellowship in spine surgery. If you're a physical therapist, there's a pathway. If you're a chiropractor, there's a pathway. If you're doing medicine management, there's a pathway. But if you're injecting medicines, which could be steroids, or PRP, or other stem cells, or other minimally invasive type of procedures, there's really no pathway for that.

• 4:40Dr. Darshan Shah?

  Right.

• 4:41Speaker 01

  We sort of get into that. Sometimes it's a physiatrist, sometimes it's a radiologist, sometimes it's an anesthesiologist. So there's no.

• 4:51Dr. Darshan Shah?

  Yeah.

• 4:51Speaker 01

  There, again, even within that realm. But that's where my specialty lies. I am a minimally invasive interventionalist, trying to sort out where the actual pain generator lies within the, well, in this case, the lumbar spine, the low back, but it could be the shoulder, it could be the knee, it doesn't matter.

• 5:14Dr. Darshan Shah?

  Right, right. So, you know, with that being said, I'd love the audience to know a little bit about you and your journey, and where you came from, and how you got into this specialty.

• 5:24Speaker 01

  Oh, that's, that's an interesting question. So I had a, I had a sports background.

• 5:29Dr. Darshan Shah?

  Right.

• 5:29Speaker 01

  And.

• 5:30Dr. Darshan Shah?

  You were like, you had an award in your college, right? You were.

• 5:35Speaker 01

  I played tennis for Vanderbilt. I was the team captain of the Vanderbilt tennis team. And I was Scholar-Athlete of the Year. So I really made it more on my academics than my, than my athletic tennis ability. But I still continue to play and, and compete. So when I went to medical school and residency, I really wanted to get into sports medicine, but there was no real pathway for that at that time. And I did not like surgery, no offense. I know you're a surgeon. And so I went into physical medicine and rehabilitation as that was the best field for me. And I started discovering, I met some folks

• 6:19Speaker 01

  that were doing interventional, minimally invasive, interventional treatments. And I went around the country learning from them. Specifically, there was a gentleman in Atlanta at Emory, where I trained, that was doing this. And then there was a radiologist in New Orleans, Charlie April, who I spent a lot of time with, learning from him and learning these various techniques. And so within that, I think of myself as a special delivery truck driver. I'm able to put the needle in the spine and access places that are, that are hard to get. But I like things where you get fairly quick results. And I don't like, surgery was just too invasive.

• 7:03Dr. Darshan Shah?

  Yeah.

• 7:03Speaker 01

  But I spend all my time in the operating room. All these procedures are really done in the OR.

• 7:08Dr. Darshan Shah?

  Yeah. Yeah, I think surgery as a profession, just all of it, is getting less and less invasive because the body heals faster, there's less post-operative pain, greater function and speed to getting, gaining your function with more minimally invasive procedures.

• 7:23Speaker 01

  Exactly. And, and, and virtually no tissue destruction.

• 7:27Dr. Darshan Shah?

  Right.

• 7:28Speaker 01

  So even.

• 7:28Dr. Darshan Shah?

  Collateral damage.

• 7:29Speaker 01

  Even the surgeons are doing things through, through small tubes.

• 7:34Dr. Darshan Shah?

  Yes.

• 7:34Speaker 01

  And, and dilating areas so that, so that the recovery is much better.

• 7:40Dr. Darshan Shah?

  Exactly.

• 7:40Speaker 01

  But still, we've got to be able to precisely identify where the problem is, or the treatment is, is less likely to, is less likely to work.

• 7:50Dr. Darshan Shah?

  Right, right. I think the more minimally invasive surgery gets, the more precise it has to be because you're going right towards where you need to be to create the fix without damaging surrounding tissue.

• 8:02Speaker 01

  Correct.

• 8:02Dr. Darshan Shah?

  Which is the opposite of where surgery used to be. Just, you know, it used to be, when I was training in surgery, wide exposure is what we would call it.

• 8:10Speaker 01

  Exactly.

• 8:10Dr. Darshan Shah?

  Open up as much as you could.

• 8:12Speaker 01

  Right.

• 8:12Dr. Darshan Shah?

  You can see everything and work. But it created a lot of destruction of normal tissues, which would then lead to prolonged recoveries.

• 8:20Speaker 01

  Exactly, exactly. And if we can get at things with much less, that's why I like to say maybe a surgeon with a needle. If we could just precisely put medicine there and alleviate pain long enough such that people can then function more in a rehab program, hopefully, we can avoid surgery altogether.

• 8:40Dr. Darshan Shah?

  Right.

• 8:41Speaker 01

  Where I think spinal intervention fails, the stuff that I do, is when things are so mechanical, such as the spine has tremendous instability, okay? That needs to be stabilized. And then another area where, where surgery really, I think, is, is strong is when there's so much stenosis or stenotic narrowing or constriction. That has to be decompressed. That has to be opened up.

• 9:12Dr. Darshan Shah?

  Got it.

• 9:13Speaker 01

  But other than that, I think there's a huge room for these minimally invasive procedures. And there are so many more procedures that it's just getting better and better. It's, it continues to excite me because we're getting, we're getting more and more dialed in.

• 9:31Dr. Darshan Shah?

  Right. And that's why I wanted to do this podcast with you because I think a lot of people with back pain, they think that they're going to have some major surgery on their back. And it doesn't have to be that way. That's not the algorithm anymore.

• 9:42Speaker 01

  Correct. That, or it doesn't have to be the algorithm.

• 9:46Dr. Darshan Shah?

  It doesn't have to be the algorithm.

• 9:47Speaker 01

  The problem still is, is, is for every one of me, there's probably 10 or 20 operating surgeons. So, so it's, it's still, you're, you're more likely to find a surgical treatment than a non-surgical treatment, unless you're actually out there looking for it. Just like functional medicine. I mean, getting in and diving in and figuring out, let's say, the gut microbiome, or hormone replacement therapy, or, or looking for some sort of toxic exposure, heavy metal, that's not the norm.

• 10:22Dr. Darshan Shah?

  Right.

• 10:23Speaker 01

  And it's, and it's harder to find. It's harder to find.

• 10:27Dr. Darshan Shah?

  Absolutely. So let's take a step back and give the audience some education about the back, right? So someone comes into you with back pain, and I'm sure you do an explanation about like, you, you have a model around how to explain the back to people, right? You brought some models, which is awesome.

• 10:42Speaker 01

  I did, I did.

• 10:43Dr. Darshan Shah?

  And this is a video podcast. So if you're listening, you might not be able to see this, but go to YouTube and we'll definitely post this episode there.

• 10:50Speaker 01

  Perfect, perfect.

• 10:51Dr. Darshan Shah?

  But I'd love to hear, you have such an eloquent way of explaining the spine and how it works, and why people can get into trouble.

• 10:57Speaker 01

  So let me, let me.

• 10:58Dr. Darshan Shah?

  Yep.

• 10:59Speaker 01

  Let me grab the model. Okay, so first of all, I like to think of the spine in terms of three columns. A, an anterior column, or a column in the front, a middle column, and a posterior column, or a column in the back. And the problem with me thinking about it this way is the literature also has a three-column model, and that three-column model is built around trauma. And so the columns I'm talking about are different than the columns that are in the literature.

• 11:35Dr. Darshan Shah?

  Right.

• 11:35Speaker 01

  Okay, so I have sort of restated the columns and simplified it to understand various conditions, okay? So there's a front column, a middle column, and a back column, okay? The front column is basically your discs and vertebral bodies. And the middle column is where your spinal nerves are, okay? And then the back column is where your facet joints are. And so generally speaking, you're gonna have problems in one of those columns.

• 12:10Dr. Darshan Shah?

  Got it, okay.

• 12:11Speaker 01

  And then surrounding all this is muscle. So the muscle provides a muscular stabilization system around these columns, okay? The disc is incredibly interesting because it is not only built to withstand load, it's built to help stabilize your spine.

• 12:36Dr. Darshan Shah?

  Okay.

• 12:36Speaker 01

  But it's also built for mobility as well, okay? So the spine is curved, it has what's called this lordosis, because the spine is built not only for stability, but mobility. So it's actually part of how we walk. This spinal mobility is what allows us to walk efficiently, okay? That's why buildings are straight, because they're just built for stability.

• 13:08Dr. Darshan Shah?

  Right.

• 13:08Speaker 01

  They're not built curved because they're not gonna pick up and leave and go to another location.

• 13:13Dr. Darshan Shah?

  Right.

• 13:14Speaker 01

  So this disc is a structure that's been adapted that allows us to have a slender torso. Otherwise, if we had a real joint there, like a hip joint, we'd have to have a huge muscular system around that area to stabilize, okay? The problem is, is the disc is susceptible to tearing. So when you bend backwards, you're limited in rotation.

• 13:43Dr. Darshan Shah?

  Right.

• 13:43Speaker 01

  Because of these facet joints in the back. But when you bend over and let's say turn, you can now get considerably more range of motion.

• 13:53Dr. Darshan Shah?

  I see, right.

• 13:54Speaker 01

  And the disc can tear, okay? And what a lot of people don't understand is, that can be asymptomatic for years, for years and years and years.

• 14:05Dr. Darshan Shah?

  I did not know that.

• 14:06Speaker 01

  Only the outer third of the disc is innervated by nerve fibers.

• 14:13Dr. Darshan Shah?

  Ah, okay.

• 14:13Speaker 01

  So the disc can have tears on the inside, be totally asymptomatic. And the other thing about the disc is that it doesn't have a blood supply, at least initially. So it doesn't see any blood. It gets nutrition through imbibation from the bones above it and below it.

• 14:34Dr. Darshan Shah?

  Got it.

• 14:35Speaker 01

  So the disc will tear, you'll set up little M-plate fractures, totally asymptomatic, okay? But then you start that inflamaging process that y'all like to talk about, okay?

• 14:46Dr. Darshan Shah?

  Right.

• 14:46Speaker 01

  And that process can take years to develop, okay? And then at some point, there's the straw that broke the camel's back. Well, that's not what caused the problem. The problem started years earlier.

• 15:00Dr. Darshan Shah?

  Sure.

• 15:00Speaker 01

  With these asymptomatic issues.

• 15:03Dr. Darshan Shah?

  Got it.

• 15:04Speaker 01

  So that's one thing you have to realize, that this process goes on for a while, and a lot of it is asymptomatic.

• 15:12Dr. Darshan Shah?

  Yep. So the people that have problems with their discs, they've overstretched in the wrong direction and over rotated.

• 15:22Speaker 01

  Perhaps, most likely, yes.

• 15:23Dr. Darshan Shah?

  So these are people that are probably picking up with their back instead of using their legs?

• 15:27Speaker 01

  That's correct.

• 15:28Dr. Darshan Shah?

  What are some other things?

• 15:28Speaker 01

  Or play sports, what if they play hockey?

• 15:31Dr. Darshan Shah?

  Right, right.

• 15:31Speaker 01

  And the hockey puck goes behind them, and they all of a sudden have to react to it.

• 15:35Dr. Darshan Shah?

  Got it.

• 15:36Speaker 01

  You know, there's all these little micro injuries that occur in life.

• 15:39Dr. Darshan Shah?

  In our life, right.

• 15:40Speaker 01

  And you may never even think about them.

• 15:42Dr. Darshan Shah?

  Yep, yeah, but then they pile up.

• 15:43Speaker 01

  At some point, they pile up, and you have a back attack. Because now this injury has reached the outer third of the annulus, or you get this tear in there, and then you're very limited. You're very limited in that particular scenario.

• 16:01Dr. Darshan Shah?

  Got it, so these discs, they tear from more like the middle, and then they go outwards over time, and then they reach the nerve, and when it reaches the nerve, is when you feel it.

• 16:11Speaker 01

  So that would be in the case of the disc actually herniating and putting pressure on the nerve.

• 16:18Dr. Darshan Shah?

  Got it, okay.

• 16:18Speaker 01

  The tear in the outer periphery of the disc itself is kind of like a sprained ankle. You know, the ligament itself is innervated by nerves. So you don't have to have a pinched nerve or an irritated nerve, the disc itself, which was previously asymptomatic, now becomes symptomatic.

• 16:38Dr. Darshan Shah?

  I see, okay. So that's the front. What about the middle? What kind of trouble can people get into in the middle?

• 16:44Speaker 01

  So in the middle, you can get these pinched nerves, okay? Also in the middle, you can develop spinal stenosis. So some people are born with congenitally what we call small pedicles. And then over time, as they get wear and tear, the middle column gets stenotic or narrowed, and the nerves get pinched. And we call that claudication. There's neurogenic claudication, and then of course, there's vascular claudication. It's basically lack of these nerves being able to breathe. They get stenotic.

• 17:24Dr. Darshan Shah?

  Got it.

• 17:25Speaker 01

  And that's where those folks, that usually happens much later in life. That's, you know, 60s, 70s, in there, people develop these issues with spinal stenosis.

• 17:35Dr. Darshan Shah?

  Makes sense.

• 17:36Speaker 01

  That's a large part of the middle column.

• 17:38Dr. Darshan Shah?

  Got it.

• 17:38Speaker 01

  And then the posterior column are where the facet joints and the multifidus muscles live, which provide a degree of stabilization and mobility. And these joints are what pop when you go to the chiropractor. And they're very easy to reach with the needle because they're in the back.

• 17:59Dr. Darshan Shah?

  Yep.

• 18:00Speaker 01

  And so one of the problems with spinal intervention is that the majority of chronic pain, not all of it, but the majority of chronic pain is more in the anterior column. And that's, let's say, 40%. And then maybe 15% is in the posterior column, okay? But about 99% of the procedures are done in the posterior column, and less than 1% of the procedures are done in the anterior column. So unfortunately, we're approaching the spine from the back and only addressing a very small minority of problems

• 18:42Speaker 01

  instead of approaching the spine where most of the problems are. That's one of the biggest problems that I see for patients, is that they're getting treated for problems that are less frequent.

• 18:58Dr. Darshan Shah?

  Right.

• 18:59Speaker 01

  Only because it's easier to treat those problems, and there's also a better reimbursable pathway for doctors.

• 19:06Dr. Darshan Shah?

  Right.

• 19:07Speaker 01

  So those are part of the problems.

• 19:09Dr. Darshan Shah?

  And that's because mainly the front is hard to get to, right?

• 19:13Speaker 01

  Correct.

• 19:13Dr. Darshan Shah?

  I remember in general surgery, I would be called to do exposures of the front, and that itself was a major surgery, was getting the spine surgeons to get exposure to the front, because you'd have to go in through the abdomen or the groin and move a bunch of the organs out of the way and hold them there while they're operating in this deep cavern. Like, it did not look fun, what they were doing.

• 19:35Speaker 01

  That's exactly right. And so to get to the front from the back, we've got to come in from the side, and we've got to avoid the nerves, we got to avoid these transverse processes, we got to make sure we don't go too deep, let's say, into the abdomen, or we're gonna seed the spine with infection.

• 19:54Dr. Darshan Shah?

  Right.

• 19:55Speaker 01

  So that's why I call myself a special delivery truck driver. You need somebody who really has spent 10,000 hours knowing this anatomy so that they can get at these structures where the problem is.

• 20:12Dr. Darshan Shah?

  So if someone has back pain, and I'm sure you investigate back pain with MRIs, right?

• 20:16Speaker 01

  Correct.

• 20:17Dr. Darshan Shah?

  How does a person at home know if they're having problems with the front, middle, or posterior column of the spine?

• 20:24Speaker 01

  That's a great question. So I think you start with an exam, okay? And so generally speaking, people with problems in the front, they don't want to sit down. When you come into the exam room, they're not seated. They're standing in the room, waiting for you. That is a huge clue. So it starts with, you know, a history, an exam, and things like that. But then, let's take, I call it spy data. What is the spy data that you want to get in order to try to determine where the pain generator is, where the terrorist is in the spine? And I find MRI to be very useful.

• 21:07Speaker 01

  I do like the MRI a lot. Prior to MRI, we used to do a lot of CT with dye called a CT myelogram, and that can be helpful as well. But you see the patient, you examine them, you get special x-rays. I like flexion-extension films to get some sort of dynamic idea of how things are moving in the spine, and then you go to the MRI. And the MRI is very nice at showing soft tissues.

• 21:37Speaker 01

  And it's also helping to show this quote unquote, "inflammaging." So there's areas of the spine where we see inflammaging. We call those modic changes. And so those modic changes do oftentimes help identify where to attack with a, where to send SEAL Team Six, if you will.

• 22:00Dr. Darshan Shah?

  Yeah, got it.

• 22:00Speaker 01

  And so that MRI helps look at those discs. It, it helps look for changes in the bones, these modic changes. It helps look at the facets. It can show various areas of inflammation.

• 22:14Dr. Darshan Shah?

  So a patient's coming into you and I, I'm sure you either order an MRI or they've already had an MRI done. And I know this will be true because a lot of people in back surgery, sometimes people just get the wrong MRI done. So when you, when you're ordering these MRIs, are you very specific in what you tell the radiologist on what to do?

• 22:34Speaker 01

  No, I'm not. I'm not. I don't feel, as far as getting the wrong MRIs, it's these open MRIs that are really, that are really tough. So if you think about a closed MRI and an open MRI, an open MRI is easy to be in. But the magnitude of the magnet, the Tesla strength of the magnet is like taking a picture with an old cellphone. Whereas a closed MRI, a 1.5 Tesla, and now they even have three Tesla magnets. Those MRIs have much better imaging quality.

• 23:11Dr. Darshan Shah?

  Yes.

• 23:12Speaker 01

  But I don't find they get the wrong MRI.

• 23:14Dr. Darshan Shah?

  Okay, good.

• 23:15Speaker 01

  I find that, that sometimes the image quality varies from poor to excellent.

• 23:21Dr. Darshan Shah?

  Right.

• 23:21Speaker 01

  And the better the image quality, just the better you can help identify potentially the source of the, the pain via MRI. But once you have that information, then you've got to come up with some sort of plan of attack.

• 23:36Dr. Darshan Shah?

  Sure.

• 23:36Speaker 01

  To, to see if that hypothesis is actually correct.

• 23:42Dr. Darshan Shah?

  So there are other causes of back pain besides an anatomical reason to have it in, in what you just described. For example, you know, just people sitting around a lot, right? Their hip flexors can cause some level of back pain. Overtraining can cause back pain. How do you differentiate which people should get an MRI versus not get an MRI?

• 24:04Speaker 01

  Yeah, I, I have a pretty low threshold when it comes to ordering an MRI, partly because I'm going to be sticking a needle in there ultimately. And I want to make sure that there's not, let's say, an infection in there. I don't want to be blamed with my needle for causing a problem that was there to begin with. I want to make sure that, like you said, there's not an extra spinal cause like a tumor. Things like that. So infection, tumor, bleeding. I want to make sure there's no bleeding. So, so I have a low threshold, but as far as, let's say, treating other things like muscle imbalance, like from the hips and stuff like that. Most of the patients I've seen, not all of them, have been through physical therapy already.

• 24:49Speaker 01

  So, so those issues have already been somehow addressed. Now, they may have been unsuccessfully addressed because the pain is creating the muscle imbalance, which if you get rid of the pain, then they're going to be able to get rid of the muscle imbalance. So, so that's how I would sort of attack that.

• 25:11Dr. Darshan Shah?

  Got it. Makes a lot of sense. Just to be complete with the people out there that are listening to this, before they see a specialist like you and they are first experiencing back pain, what are some of the things that you could tell them to help relieve the back pain? Say it's just coming from, like you said, physical therapy, but if you don't have access to a physical therapist, what's some like general tips you can give people?

• 25:34Speaker 01

  So, so these would be my messages. Okay, so, so unfortunately, I'm still a glorified hairdresser, which means I don't get rid of the gray hair usually. I'm just putting hair color in there. So I would say the majority of spine treatment is still palliative as opposed to regenerative. And if they can avoid me, that is great. And so the major tips I, I would give, number one is walking is probably the best exercise. So I would tell people to avoid bedrest. It will not help. It will make the problem worse. And if you can do one thing, walking, walking, walking, walking.

• 26:18Speaker 01

  Again, most of these people will go through physical therapy, so they should be well versed at that. Also, you did a podcast with Dr. Yerth. That was just tremendous. So I, I would, I would refer people to that podcast because there are a lot of sort of very practical, functional medicine, longevity type things that you, that you two discussed. And briefly, she mentioned ketones. She mentioned peptides. She mentioned omega threes, cleaning up the gut microbiome. All those things that you do

• 26:53Dr. Darshan Shah?

  Right.

• 26:54Speaker 01

  is the best way of keeping the patient from me. So, so that's how I would answer that question.

• 27:02Dr. Darshan Shah?

  Right, that's a great answer, actually. I think fostering an environment of overall health can be extremely beneficial for pain relief.

• 27:10Speaker 01

  That's why I, I think you're awesome because you have, you have capsulized that in a much better way for people to, to really dig into. I think that's so important.

• 27:20Dr. Darshan Shah?

  Yeah, and I think, you know, when you're experiencing back pain, I think a lot of people get disheartened because they think they're going to have it forever. They're going to need a major surgery. They're trying to avoid surgery. So they do all the wrong things. They bedrest. They end up moving less, so they end up getting more on, they end up becoming more unhealthy. They start sitting around, eating more. They start taking pain medications chronically, which also leads to health problems.

• 27:47Speaker 01

  There are no good pain medicines, only bad ones.

• 27:50Dr. Darshan Shah?

  Exactly.

• 27:50Speaker 01

  So, so I, that, that, that pathway, you know, other than functional medicine, like supplements and longevity, but in general, medications for me have no real role in this, in this situation. In fact, all the procedures that I do, no post-op pain meds. I prescribe zero medications.

• 28:14Dr. Darshan Shah?

  That's incredible.

• 28:14Speaker 01

  And none of the procedures that I do really require post-op. And I'm doing some, some significant procedures, implanting stimulators, implanting little devices that, that cause stabilization with, with minimal incisions, but no medicines.

• 28:33Dr. Darshan Shah?

  It's so interesting you say that because even in my surgical career, when I first graduated from my residency, you were considered a very bad doctor if you did not write for three months of pain medication. And then fast forward to, you know, I stopped doing surgery five years ago to focus just on this. Five years ago, even after doing some big procedures, you don't go home with any narcotic pain medication at all.

• 28:54Speaker 01

  Excellent, excellent. I'm so glad that's turned around. You know, I went through the whole OxyContin.

• 28:59Dr. Darshan Shah?

  Right.

• 29:00Speaker 01

  You know, where the, where the reps would come in and tell you that, that, that, it's not addictive and that patients needed this. And, and I, I never went that way. I, it never made sense to me.

• 29:12Dr. Darshan Shah?

  Yeah, yeah. It's such a whole new way of thinking about pain, where early mobility after surgery, less pain medication, more anti-inflammatory type of medications instead, very temporarily, because inflammation is healing.

• 29:26Speaker 01

  But I would say anti-inflammatory supplementation. As opposed to, as opposed to Advil and things like that. Because those things actually, I think, slow down healing.

• 29:38Dr. Darshan Shah?

  I agree.

• 29:39Speaker 01

  I do think they're very good pain medicines and they're not, let's say, habit forming like some of the other ones, but I don't think they actually promote healing like some of the stuff that you do.

• 29:49Dr. Darshan Shah?

  Absolutely, absolutely.

• 29:55Dr. Darshan Shah?

  Hi, Dr. Shaw here. I want to take a minute to talk to you about cellular health. So in my clinics, I've actually seen 30-year-old people with cells that look like they're pushing retirement. And I've also seen 60-year-olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells, you see, are like phones and they have limited cellphone battery. Poor sleep, stress, processed foods, all of these things can drain that battery way faster than it should. So this is the reason why I partnered with IMA. IMA powers that cellular battery. It's not just another multivitamin. It's a comprehensive 92 ingredient formula designed specifically for cellular health and longevity.

• 30:40Dr. Darshan Shah?

  I'm talking 900 milligrams of vitamin C. That's like 20 oranges worth of DNA protection. The clinical dose of CoQ10 that you need to power your cellular engine. You also get zinc, selenium, vitamin E, alpha lipoic acid. All of these work synergistically for cellular repair and protecting your telomeres. So instead of taking a handful of pills every day and all these supplements, IMA actually gives you everything that you need in one scientifically formulated system. And this isn't just a theory anymore. IMA had partnered with Oxford University, the International Space Station, San Francisco Research Institute, and they've done studies and they've gotten this NSF certified to truly power your health.

• 31:22Dr. Darshan Shah?

  Most people are aging twice as fast as they should, unfortunately. You don't have to be one of them. Try IMA. I actually have a discount secured for you if you go to drshah.com/ima or go to im8health.com/discount/drsaw and you can get 20% off with my discount code, Dr. Shaw. You can also find the link below.

• 31:47Dr. Darshan Shah?

  Okay, so now you've seen the patient, got an MRI, and you have alternatives for people. How can they relieve their pain without major surgery? What do you, what do you start talking about at that point in time?

• 31:59Speaker 01

  So, so this is where we start talking about injections. And there are all sorts of procedures in the various columns. And typically, like I said earlier, most people start from the back and work their way to the front. And I try to start where I think the problem is, rather than just routinely starting from the back.

• 32:26Dr. Darshan Shah?

  Yeah.

• 32:26Speaker 01

  But if they haven't had, let's say, some sort of procedure, I may indeed start with what's called an epidural block. And the reason I start there is, is it's kind of like a carpet bomb. It's addressing multiple sources of potential pain simultaneously. So you're putting medicine in the middle column, but you're trying to bathe the nerves, bathe the back of the discs, bathe the facet joints, and basically give them a therapeutic window of pain relief so that they can once again restore normal activity. So I may start there. But unfortunately, most of my patients have had five or six or seven procedures,

• 33:07Speaker 01

  in which case I may start looking at things in the anterior column, putting medicine into the discs, or looking for these modic changes where there's these subtle areas of inflammation. And there are procedures such as INTERCEPT, where we can go in and burn the nerves inside the vertebral body to treat these modic changes. As an example, I recently had an athlete, who is a sprinter, just graduated from Alabama, training for the Olympics, the Los Angeles Olympics. And he, about a year and a half ago, two years ago, was in a sprint and developed incapacitating back pain.

• 33:51Speaker 01

  And was sent to me after he failed these blocks to, to treat this anterior column problem. And so we had to figure out what procedure to offer him to try to get him back to sprinting. And what I like about this is you can actually measure his function because his, his event is measured in microseconds. You know, there's a microsecond of a difference between him and the next guy. But, but at the time, I mean, he could barely walk. I mean, he was, he was incapacitated. And so it was sort of, do we do an intradiscal, let's say steroid injection?

• 34:32Speaker 01

  Do we do an intradiscal regenerative injection like PRP? Or do we look at, let's say, INTERCEPT? Because he had these subtle modic changes. And I decided that INTERCEPT for him seemed like the best option at the time because I saw no downside. Even, so people think, oh, I'm going to get a stem cell injection in my disc. Well, there are no currently available stem cells that have been shown to actually regenerate the disc. Now, there are, there is a company, DiscGenics, that is in research trials, where their Phase 1, 2 trial actually shows some regeneration. So we're getting better.

• 35:15Speaker 01

  But, but even putting a needle in the disc can potentially cause damage to the conjic sites or the disc cartilage and cause the disc to degenerate. So in somebody like him, where every millimeter counts, I did not want to go into the disc if I could avoid it.

• 35:36Dr. Darshan Shah?

  Right.

• 35:37Speaker 01

  So I started with INTERCEPT. I burned the nerves above and below the disc space. And he had a tremendous result. He's now training for the Los Angeles Olympics.

• 35:46Dr. Darshan Shah?

  Wow, what an awesome story.

• 35:47Speaker 01

  Yeah.

• 35:48Dr. Darshan Shah?

  That's fantastic.

• 35:49Speaker 01

  It's a great story.

• 35:50Dr. Darshan Shah?

  Going back to the epidural, to your point, like this is like a carpet bomb where you're just basically numbing everything.

• 35:56Speaker 01

  Correct.

• 35:56Dr. Darshan Shah?

  So they get some relief. But that relief leads to increased mobility. And that mobility then leads to the symptoms getting better. Is that kind of what you're saying?

• 36:06Speaker 01

  That is what I'm saying. And, and also what I'm saying is no one ever dies from back pain.

• 36:10Dr. Darshan Shah?

  Right.

• 36:11Speaker 01

  What people die of is lack of activity from their back pain. So all the problems of not exercising is really what cause high blood pressure, cause obesity, diabetes, bone loss. I mean, all, so activity is your, your longevity molecule. So you've got to, you've got to stay active in spite of your back pain. And if you can't stay active in spite of your back pain, that's where trying to figure out something that causes relief to allow for activity is ultimately going to promote your health.

• 36:48Dr. Darshan Shah?

  Absolutely. And, you know, I think about, you know, when you see some elderly individuals that look very frail, a lot of them, that frailty started from back symptoms because they just stopped moving.

• 37:00Speaker 01

  They stopped moving. A lot of, in the rehab world, a lot of patients that are in wheelchairs actually put themselves in wheelchairs.

• 37:08Dr. Darshan Shah?

  Yeah.

• 37:09Speaker 01

  And, and if these people would just exercise, they could get out of these wheelchairs.

• 37:15Dr. Darshan Shah?

  Right.

• 37:15Speaker 01

  So, yes, a lot of, a lot of the frailty we see is through people choosing a lifestyle that promotes inactivity, unfortunately.

• 37:28Dr. Darshan Shah?

  Yeah. And that happens because the inactivity causes sarcopenia, which greatly accelerates after the age of like 45, and then again at 70. And that loss of muscle then leads to more bone instability and worsening pain and worsening symptoms. And it's like you're chasing your tail.

• 37:45Speaker 01

  So there's, there's a new technology out called Reactivate, which, which I just, which I just love. And it's so interesting to me because for 30 years, Darshan, I would look at these MRIs. And on the MRI, they would have something called multifidus atrophy, meaning the multifidai muscle, the steak around the spine that would cause, that would promote stability.

• 38:12Dr. Darshan Shah?

  Right.

• 38:12Speaker 01

  Would atrophy. And I, I totally ignored it. I, it's like, it's like, and I never even saw it. It was like, just, it was there. And a emergency room entrepreneur comes up with a procedure to reactivate these atrophied muscles. And it involves implanting a stimulator to the nerves, what are called the medial branches, that actually stimulate these muscles to reactivate. And, and the stimulator is used 30 minutes, twice a day. And, and what happens is, is your brain shuts that pathway down. So you can no longer activate those muscles.

• 38:57Speaker 01

  And so that also promotes this multifidus atrophy. And so it bypasses the brain and it resets the nervous system to start using those muscles to cause spine stability. But more importantly, the results have been incredible.

• 39:14Dr. Darshan Shah?

  Wow.

• 39:15Speaker 01

  Where, where people who have had chronic pain for years undergo this procedure, Reactivate, reactivate these muscles and are, have enormous change in their pain, their quality of life. And, and I've had some people that, you know, they don't even use it anymore. They're, they're pain free, they're cured. One person recently, I had to take the stimulator out. He didn't want it in anymore. He didn't need it, wasn't using it.

• 39:38Dr. Darshan Shah?

  Incredible.

• 39:39Speaker 01

  Yeah. So, so that, that's another, I want to plant that seed. There are just, there are so many new technologies that are so exciting for back pain. And that, that would be one of them as well.

• 39:52Dr. Darshan Shah?

  That's incredible. I had no idea this existed. So, okay, so let's go back to the spinal column. So the front column, you have three options. You can use the procedure to deactivate the nerves. You can inject steroid.

• 40:05Speaker 01

  Or let's say stem cells or something like that.

• 40:08Dr. Darshan Shah?

  Stem cells or PRP, right?

• 40:09Speaker 01

  Yeah.

• 40:10Dr. Darshan Shah?

  Now.

• 40:10Speaker 01

  As an example, we'll use PRP as a stem cell.

• 40:13Dr. Darshan Shah?

  Sure.

• 40:13Speaker 01

  Equivalent.

• 40:14Dr. Darshan Shah?

  Right, right. So between those two, injecting a steroid versus a regenerative, let's just call them regenerative, how do you make a decision?

• 40:23Speaker 01

  Great question. I lean toward the steroid for, for many reasons. Okay? It's cheap. And you get, and you get an answer whether or not that, that works. Okay? Where I start looking at stem cells is mostly in my practice, I want to put them in a research trial. I, I want to really study it scientifically, where we have a randomized control placebo arm and we know what works. But some people obviously don't want to be in a placebo group and they're willing to pay for their stem cells. It's expensive. So that's not really my population. The other problem I have with, let's call it PRP or stem cells, because you can get bone marrow aspirate,

• 41:07Speaker 01

  is I don't like all the processing. In other words, this area has very poor blood supply and I don't want to introduce infection into that area.

• 41:16Dr. Darshan Shah?

  Right.

• 41:17Speaker 01

  And so when you start drawing blood, spinning blood, processing the blood, and it starts changing hands a lot, I think there's a, a risk of infection. Whereas ultimately, I hope there's going to be an off the shelf product. Maybe it comes in a, in a, in, in dry ice or something that has to be cooled. But there's going to be minimal processing. And so it's going to be sterile. It's going to be FDA controlled. So, so I lean more toward the steroid. And also, the PRP is not going to be regenerative. So if it works, it's going to be working like a steroid.

• 41:54Dr. Darshan Shah?

  Right.

• 41:54Speaker 01

  So that's just my bias. Okay? I'm not saying that that's correct. That's, that's my bias.

• 41:59Dr. Darshan Shah?

  It's great to have your perspective on it because I think we live in this world now where, you know, you see these biohackers going and getting their entire spine prophylactically injected with stem cells. You've heard about this, right? And also.

• 42:14Speaker 01

  But they're not getting put in the right place.

• 42:17Dr. Darshan Shah?

  That's what I thought. Like, where are they putting these?

• 42:19Speaker 01

  There's no way they're getting, they're getting these stem cells in the right place. So if they're working, they're working on an anti-inflammatory pathway. They're working like a steroid anyway.

• 42:29Dr. Darshan Shah?

  Anyway, right.

• 42:30Speaker 01

  And then some of them are doing it IV, which would be a systemic way of doing it, which is fine. But I, I will say this, there's no imaging that, that they can show me that will show the spine actually regenerating.

• 42:43Dr. Darshan Shah?

  Right.

• 42:43Speaker 01

  So that, that's not out there. That's not prime time yet.

• 42:47Dr. Darshan Shah?

  Yeah. And to your point also about the processing leading to infections, I think I want to just double click on that a little bit. Processing means you take the stem cells out of your body, you run them through a bunch of machines. Just by doing that, you can introduce bacteria because you've taken cells out of the body and you're putting them back in and running them through machines. And there's been some pretty well-publicized cases of people in the health and wellness field that have had severe infections of their back because of this, right?

• 43:15Speaker 01

  Right.

• 43:15Dr. Darshan Shah?

  And so this is an extremely important topic that needs to be talked about when you're going to have one of these procedures is those infections can be a thousand times worse than the actual problem. I mean, people can actually almost die from them, you know?

• 43:30Speaker 01

  Right. Which is again, again, I go back to the steroid, very simple, very cheap. It's manufactured by an FDA facility, like, like a shearing plow, a Pfizer, something like that comes in a bottle, it's sterile, you know it's sterile. It's just, I just like the low cost, low morbidity aspect of that.

• 43:52Dr. Darshan Shah?

  Right. I want to ask you about the steroids as well because from my knowledge, I know steroids are very anti-inflammatory and that's how they have an effect. However, long-term, many steroids injections to the same place can also be degenerative. Is that true? And how does that work in the spine?

• 44:08Speaker 01

  So, so, so everything is degenerative to the disc. The, the needle is degenerative to the disc. The needle itself.

• 44:16Dr. Darshan Shah?

  That's a good point.

• 44:16Speaker 01

  The contrast, the anesthetic we put in there, this, everything is degenerative to the disc. What we want to avoid, again, I go back to the hairdresser. The, the more I see you, the worse job I've done. The less I see you, the better job I've done. So yes, I am putting a Band-Aid in there, but hopefully we're finally getting at where the problem is. And in creating a pain-free window such that, that we've actually, we've one diagnosed the problem and, and then we can start looking at other things that may potentially give a longer lasting effect, although maybe more, more expensive.

• 44:53Dr. Darshan Shah?

  Yeah.

• 44:54Speaker 01

  Yeah.

• 44:54Dr. Darshan Shah?

  Makes sense.

• 44:55Speaker 01

  That would be, that would be fun podcast where we take a case or we take a patient, we go through it.

• 44:59Dr. Darshan Shah?

  Right.

• 44:59Speaker 01

  Um, and really, because there's a lot, there's a lot of, there's a lot of, you know, how are we getting at, you know, what procedure to do? Should we, should we burn the nerve? Should we put in a stimulator, uh, things like that?

• 45:12Dr. Darshan Shah?

  I just referred you a patient already. I already texted him and, and he's gonna see you. And maybe we can go through his case at some point.

• 45:19Speaker 01

  Yes, that would be, that would be, that would be a blast for me. Yeah. That, that's really what I, I like to be a, a bit of a detective to try to figure out what exactly is driving, driving this situation. There's another procedure called SPRINT, which I brought a little thing.

• 45:34Dr. Darshan Shah?

  Yeah. Tell me about this one.

• 45:35Speaker 01

  This is, this is a peripheral nerve stimulator.

• 45:38Dr. Darshan Shah?

  Okay.

• 45:39Speaker 01

  And, uh, the, the, the wire is, is what you see in the lucite there. It's just a little, it's just, it's basically implanting a TENS unit.

• 45:47Dr. Darshan Shah?

  Oh, okay.

• 45:48Speaker 01

  Into, and you can put it in the shoulder, you can put it around, then you can put it anywhere. And it's temporary. You can only leave it, that's good news, bad news. You can only leave it in for 60 days.

• 45:58Dr. Darshan Shah?

  Okay.

• 45:59Speaker 01

  If you love it, we've got to pull it out. And if you hate it, we can pull it out.

• 46:03Dr. Darshan Shah?

  Yeah.

• 46:04Speaker 01

  So it's really easy and.

• 46:05Dr. Darshan Shah?

  60 days.

• 46:06Speaker 01

  Yeah. 60 days is the longest you can leave it in. But what it does is it, it's like putting an electrical current around the pain and blocking pain.

• 46:16Dr. Darshan Shah?

  Yeah.

• 46:16Speaker 01

  And then because of the neuroplasticity of the brain, the brain starts to remodel and basically has less chronic pain. That's the goal, isn't it?

• 46:26Dr. Darshan Shah?

  Mm-hmm.

• 46:27Speaker 01

  It works. It doesn't work all the time, but, but it's so easy to do and, and has enough of a, of a success rate. And it's easy on the patient that, that that's a, another avenue people can explore.

• 46:41Dr. Darshan Shah?

  Yeah. I've never heard of that one either. They're teaching me all sorts of new techniques.

• 46:45Speaker 01

  Medtronic just bought that company about a month ago.

• 46:47Dr. Darshan Shah?

  Ah.

• 46:47Speaker 01

  So I have a feeling it's going to become a lot more mainstream because now it's owned by a major pharmaceutical or interventional company.

• 46:57Dr. Darshan Shah?

  Got it.

• 46:58Speaker 01

  Medtronic's huge, so.

• 46:59Dr. Darshan Shah?

  Huge company. In the middle column of the spine, you talked about stenosis and a lot of people get diagnosed with spinal stenosis. What are some solutions there?

• 47:08Speaker 01

  Ooh, that's, that's one of the tougher ones.

• 47:10Dr. Darshan Shah?

  Right.

• 47:11Speaker 01

  Okay. It depends what the, the stenosis is due to, okay? Oftentimes, the, the spine develops hypermobility where it's, it's overly mobile. And you can, there are some telltale clues that there's hypermobility. On the X-ray, you'll see some slippage called spondylolysis.

• 47:34Dr. Darshan Shah?

  Okay.

• 47:34Speaker 01

  Okay. You get flexion, extension films and you can see this subtle hypermobility where things are moving too much.

• 47:42Dr. Darshan Shah?

  Okay.

• 47:43Speaker 01

  So because of this overmobility, the tissues, what's called the ligamentum flavum in the capsule around the facet joints, they start to hypertrophy or get overgrown. And that creates, uh, basically space occupying stuff inside the, the spinal canal. Another reason you wouldn't, you wouldn't want to put stem cells in there.

• 48:05Dr. Darshan Shah?

  Right.

• 48:05Speaker 01

  Well, you're not trying to, you, you have too much growth in there, right? You want the anti-effect. You want to be able to clean this out, not, not cause growth, okay? But anyway, in the middle column, you develop areas of stenosis. Sometimes you see cysts off the facet joints.

• 48:24Dr. Darshan Shah?

  Oh.

• 48:24Speaker 01

  You know, like people get these like cysts in their wrists and they hit them with a bible?

• 48:28Dr. Darshan Shah?

  Right.

• 48:28Speaker 01

  You can get cysts in these joints.

• 48:30Dr. Darshan Shah?

  Got it.

• 48:30Speaker 01

  Which again, push on the nerves.

• 48:32Dr. Darshan Shah?

  My dad had one of those.

• 48:33Speaker 01

  Had a facet cyst?

• 48:34Dr. Darshan Shah?

  Had a cyst and a ma- major pain. And then he had a minimally invasive procedure to remove the cyst. Pain gone.

• 48:41Speaker 01

  Perfect.

• 48:41Dr. Darshan Shah?

  Yep. But, you know, his challenge there was it took three doctors looking at the same MRI for one to finally notice there was a cyst.

• 48:51Speaker 01

  You've got to.

• 48:51Dr. Darshan Shah?

  He was scheduled for a major surgery.

• 48:52Speaker 01

  You've got to really study these images. And, and again, this is where an injection might be nice because a lot of times I'll inject the cyst and I'll try to rupture the cyst, uh, with fluid.

• 49:02Dr. Darshan Shah?

  Right.

• 49:03Speaker 01

  And, uh, and that will resolve the problem. Unfortunately, the cyst can come back. So if it keeps coming back and coming back, you have to remove it. But there is a procedure called Minuteman, which is a little jack we put in the posterior column to try to indirectly decompress the central column. So it's not a direct decompression like a surgeon would do.

• 49:27Dr. Darshan Shah?

  Yeah.

• 49:28Speaker 01

  It's an indirect decompression. It creates a little jack in the back.

• 49:32Dr. Darshan Shah?

  Yeah.

• 49:33Speaker 01

  To open that up, plus it fuses the bone. So it corrects the instability that I was talking about. And sometimes about, I would say 50 to 75% of the time, it can fix the problem such that they don't have pain. Though sometimes the problem with these minimally invasive procedures for the problem you're talking about is they're not robust enough.

• 49:57Dr. Darshan Shah?

  Right.

• 49:58Speaker 01

  To create enough decompression. But this can be put in in 30 minutes. You come in from the side. It's a very small incision. There's minimal recovery and you put this little, this little jack, and I call it a jack in the back.

• 50:12Dr. Darshan Shah?

  Yeah.

• 50:12Speaker 01

  Into the spine to create. So we've got, we've got something for everything.

• 50:16Dr. Darshan Shah?

  Yeah, yeah. Yeah. And it's like, to your point, it's like better to start minimally invasive and then go in and do a, a major decompression surgery because that's a big surgery.

• 50:25Speaker 01

  Absolutely. And also you want to really try to establish where the problem is before you do the surgery. So sometimes these injections can help, not all the time, but can help isolate, hey, this is where we really need to cut.

• 50:39Dr. Darshan Shah?

  Got it. Any other procedures? I mean, it seems like you have a huge bag of tricks here. Is there any procedures that we haven't talked about?

• 50:45Speaker 01

  Well, I mean, we haven't talked about very common ones, um, like to the facets, we do what's called radio frequency to these, to these joints where we burn the nerves to the joints.

• 50:56Dr. Darshan Shah?

  Mm-hmm.

• 50:56Speaker 01

  We've, are slowly getting away from that because we're starting to understand this concept of multifidus atrophy.

• 51:04Dr. Darshan Shah?

  Mm-hmm.

• 51:04Speaker 01

  So when we burn the nerves to these joints, we're actually burning the nerves to those muscles.

• 51:09Dr. Darshan Shah?

  Right.

• 51:09Speaker 01

  Now, we haven't really seen a problem with that, okay? But maybe because we haven't looked for it.

• 51:15Dr. Darshan Shah?

  Hmm. Yeah.

• 51:16Speaker 01

  Um, and I think we've covered a lot. I, I can't really, you know, I think we've covered a lot of ground. I think we've laid the groundwork for a lot of different, a lot, there are a lot of tools out there that people can explore.

• 51:29Dr. Darshan Shah?

  Absolutely.

• 51:30Speaker 01

  Absolutely.

• 51:31Dr. Darshan Shah?

  And that's why I wanted to have this conversation with you. I see a lot of people come in with back pain. They've probably seen two or three surgeons, they've done physical therapy for a long time, been injected multiple times, and they've lost hope. And they've lost hope because the, the next step is a major back surgery. Maybe it's a major fusion surgery, a disc replacement, those kinds of things. Um, and it's only because they haven't been knowledgeable about anything in between, right?

• 52:01Speaker 01

  In, in this area of spinal intervention is a bit of a black box. You, you really don't know what you're going to get, unfortunately. Which is why I love what you do because this is all about education.

• 52:14Dr. Darshan Shah?

  Exactly.

• 52:14Speaker 01

  That's why I'm here today. I'm just here to, to give that message that the more knowledgeable the patient can be about their own problem, then they can find solutions that are tailored toward them.

• 52:26Dr. Darshan Shah?

  Absolutely. So to sum it all up, someone's experiencing back pain out there, um, and they are, you know, going down the pathway of physical therapy, getting MRIs, maybe being referred to a surgeon. What advice can you give them?

• 52:43Speaker 01

  Well, a couple of things. Number one, let's hit on the big things that they have to figure out ways of staying active.

• 52:50Dr. Darshan Shah?

  Right.

• 52:50Speaker 01

  They've got to figure that out because inactivity is really what leads to all the problems. And then if they could go back to your show with Dr. Yerth, I would really encourage that because, you know, getting their health in order is important. Finding somebody like me can be challenging, unfortunately. I would look toward interventionalists that are part of the North American Spine Society that, let's say, teach, that have fellowships in teaching spinal intervention. There's another group called IPSIS, International Pain and Spinal Intervention Society. It used to be called ISIS. They had to change the name.

• 53:26Dr. Darshan Shah?

  Oh, my gosh.

• 53:27Speaker 01

  So.

• 53:29Dr. Darshan Shah?

  Yeah, good thing they changed the name.

• 53:30Speaker 01

  But there are societies. There's NANS, the North American Neuromodulation Society. There's ASAP, the American Society of Interventional Pain Physicians. But sort of researching this sort of area requires the same type of diligence as finding somebody like you. How do they find you?

• 53:50Dr. Darshan Shah?

  Right.

• 53:51Speaker 01

  Right? Tell me.

• 53:52Dr. Darshan Shah?

  And it's hard to even describe what I do, right? I mean, am I a longevity doctor? Am I a functional medicine doctor, lifestyle medicine? I'm all of it altogether, but there's no word for that.

• 54:02Speaker 01

  Right.

• 54:02Dr. Darshan Shah?

  So you have to just really, to your point, you have to do the research, you have to look at the organizations, find people that have been trained.

• 54:09Speaker 01

  Right. And getting to you has got to be hard. You are so busy. So who is, you know, who is the next guy? Or who is the guy that is doing what you're doing, but is able to really see me and really work on this?

• 54:23Dr. Darshan Shah?

  Right.

• 54:24Speaker 01

  Which is why I love Next Health, all these different organizations that are focused on health.

• 54:31Dr. Darshan Shah?

  Yes. Yeah, we try to make it easy for you to find someone by putting one in every Next Health.

• 54:36Speaker 01

  Exactly.

• 54:37Dr. Darshan Shah?

  Yeah, and they all listen to the podcast, so now they become more knowledgeable about spinal interventions by listening to you, of course.

• 54:45Speaker 01

  Right. That's the goal.

• 54:46Dr. Darshan Shah?

  That's the goal. And then how can people find you? If, I know you probably don't want to drum up any business here, but because you're super busy, but.

• 54:54Speaker 01

  So I'm not tech savvy. I'll just say that. I work at Ortho Alabama Spine and Sports in Birmingham, Alabama. I'm sure that they can find me through this podcast, through typical Google searches. I don't think it's hard to find me.

• 55:10Dr. Darshan Shah?

  Yeah, that's fantastic. Well, this has been incredibly educational for me. I learned so much on this. So really appreciate you coming on the podcast. For the listeners out there that are suffering from back pain and know someone that is suffering from back pain, know you have options and there is a lot of education you do on yourself. I know there's some really good books out there as well on back pain that I've read before. Do you have any book recommendations for people?

• 55:37Speaker 01

  Ooh, there are so many good books. I would really, unfortunately, I would push people more toward the longevity books.

• 55:45Dr. Darshan Shah?

  Yes, that's true.

• 55:46Speaker 01

  As opposed to, because those are just so much more comprehensive in terms of diet, exercise, and things you can do. There's a gentleman by the name of Stuart McGill, who really goes over back exercises.

• 56:00Dr. Darshan Shah?

  That's the one I was referring to, McGill's book.

• 56:02Speaker 01

  Right. And he's got these big three exercises. But again, that's not necessarily going to prevent you from tearing a disc.

• 56:09Dr. Darshan Shah?

  No.

• 56:09Speaker 01

  Because a lot of the initial injuries could be asymptomatic. They could be happening because you don't even know it. But he does emphasize excellent mechanics. And so, you know, if we could all use excellent mechanics all the time, it would be great. But I don't think that's necessarily practical because, you know, we live in a very dynamic world.

• 56:31Dr. Darshan Shah?

  Right.

• 56:31Speaker 01

  So, but yeah, I think, I think exercise, there was a guy named Sarno, John Sarno. He wrote a book called Mind Over Back Pain, which is kind of fascinating. And there was a movie called All The Rage, that all kind of interesting. And that's how, you know, how to maybe help with chronic pain. But my focus is more on, you know, getting at the source of the pain as opposed to managing the pain through psychology.

• 56:59Dr. Darshan Shah?

  Yeah. And your focus on when people really need relief and they have an anatomical reason for this and providing them with options.

• 57:07Speaker 01

  Yes.

• 57:07Dr. Darshan Shah?

  I have a few patients that had read Sarno's book, two patients, and they both agreed that by the time they got to chapter four, their pain was less than 50% of what it used to be. So that's also been a very powerful book for them. And, you know, there's a lot of mind over matter. I would say a lot of maybe placebo effect and some of this stuff.

• 57:26Speaker 01

  I'll tell you something funny. I used to love listening to Howard Stern's radio show, True Story. Howard Stern used Sarno. And, you know, he wrote a couple of books. And in one of his books, he has a chapter on Sarno. In his chapter on Sarno, explains Sarno better than Sarno. So if you read Sarno, it's very confusing.

• 57:47Dr. Darshan Shah?

  Yeah.

• 57:48Speaker 01

  But if you read Howard Stern's book from 30 years ago, that one chapter, it explains Sarno better than Sarno could. So I'm always looking for the hack.

• 57:57Dr. Darshan Shah?

  That's a great tip.

• 57:58Speaker 01

  There's the hack for you.

• 58:00Dr. Darshan Shah?

  That's a great hack. Well, thank you so much for this incredible conversation.

• 58:05Speaker 01

  Darshan, thank you for letting me come on and talk about what I'm passionate about. Again, thank you for what you're doing. I love your show.

• 58:12Dr. Darshan Shah?

  Thank you. And I'm so glad you're passionate about this because so many people, I'm sure you've helped their suffering, and this will help even more. So thank you.

• 58:19Speaker 01

  I hope so. Thanks, Darshan.

• 58:24Dr. Darshan Shah?

  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 to 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.