Low Back Pain and How Best to Manage It with Dr. Leo Kormanik, Dr. Matt Pisanelli, and Zach Goulet

Mind Body Marathon

In this episode of the MindBody Marathon, Dr. Leo Kormanik, Dr. Matt Pisanelli, and Zach Goulet discuss low back pain, especially relevant since a significant portion of the adult population experiences it. They introduce themselves while donning festive holiday attire and share personal anecdotes about their experiences with back pain.

The conversation touches on the misconception that such injuries are always related to significant strain, highlighting that low back pain can result from seemingly minor actions, like bending over to pick something up. They explain that many back injuries may not even stem from a single event but rather build up over time, akin to a dam breaking under pressure.

The hosts also discuss the various causes of low back pain, including disc issues, which can be asymptomatic or cause significant discomfort, and issues related to posterior elements, such as facet joints. Muscle spasms are also common in back injuries, often acting as a protective response. Additionally, they mention that visceral issues, like kidney stones or reproductive problems, can manifest as referred back pain.

The episode concludes with a discussion about sciatica, explaining how it can be caused by nerve impingement in the lower back and how systemic inflammation from poor diet can exacerbate nerve issues. They suggest that managing overall body health and focusing on core stability can help alleviate and prevent low back pain.

They explain that disc problems can vary significantly, with central, paracentral, and lateral herniations affecting movement and treatment approaches differently.

The McKenzie method is introduced as a movement-based treatment strategy that emphasizes exercises to restore spinal function and alleviate pain, particularly for disc issues. The hosts elaborate on how certain movements can either exacerbate or relieve pain depending on the type of disc issue. They stress that not all disc problems are created equal and emphasize the importance of understanding the specific nature of a disc issue for effective treatment. Moreover, they discuss the misconception that a diagnosis of a disc herniation is dire; many people live with them without severe issues. The conversation highlights the body's innate ability to heal itself given the right conditions and treatment, contrasting this vitalistic approach with traditional allopathic methods, which often focus on invasive interventions.

They caution against the tendency to resort to surgery for milder symptoms like tingling or numbness, which were often treated more aggressively in the past. Instead, they encourage a conservative approach, highlighting the importance of recognizing "red flags" that indicate when surgical intervention may be necessary.

The conversation transitions to practical techniques for managing chronic back pain, particularly for the majority who experience tightness or discomfort without severe issues. The hosts recommend the McKenzie method, particularly exercises like press-ups, which help decompress the spine without using back muscles. They also stress the importance of maintaining hip flexor flexibility to prevent undue stress on the back.

They warn against excessive stretching of tight muscles, suggesting that the focus should be on normalizing movement and gradually easing muscle tension without overextending.

They express caution about using planks for patients with severe pain due to the potential for increased abdominal pressure and spinal stress. Instead, they recommend diaphragmatic breathing, which engages the diaphragm and helps stabilize the spine, as well as the McGill Big Three exercises, which include gentle movements to strengthen deeper spinal muscles without excessive strain.

The hosts emphasize the significance of activating the transversospinalis group, which can atrophy with chronic back pain, leading to muscle spasms. They argue against aggressive core exercises, suggesting that movements like side planks, dead bugs, and glute bridges are more beneficial for rehabilitation.

Additionally, they touch on the prevalence of osteopenia among runners, highlighting the need for foundational core work to support spinal health. They also discuss the impact of poor posture, especially during prolonged sitting, as a major contributor to back pain.

Finally, they address the use of heat versus ice for pain relief, recommending heat for stability but cautioning against using it while in a stretched position. They suggest ice for very acute pain but acknowledge that it can sometimes exacerbate discomfort. Overall, the conversation underscores the importance of movement, proper exercise, and awareness of posture in managing and preventing back pain.

You can order the Dr. Leo Kormanik's book Faster Without Fail on Amazon at https://amzn.to/4eEsB7M.

Be sure to also check out Dr. Leo's Running Rehab YouTube page at www.YouTube.com/@RunningRehab.