Even with their in-depth medical training, doctors can brush off accidents and deny the possibility of a lumbar issue. It’s not until the pain persists or worsens that they come to terms with the possibility of having a longer-term injury. 

Doctors can even experience a sense of shame about having a spine problem while being a spine expert. 

On this episode of Back Talk Doc, Dr. Sanjiv Lakhia invites his colleague and friend Dr. Joseph Cheatle, a neurosurgeon at Carolina Neurosurgery and Spine Associates, to discuss the personal challenges that he has faced with low back pain. 

Dr. Cheatle’s injury occurred following a skiing accident where they were hit by another skier. Initially, he brushed off the incident, but over time, he began experiencing increasing discomfort in his back and buttocks. As the pain worsened, he realized the challenge of diagnosing his own condition.

Even after finally seeking professional help with his injury, which included physical therapy and an MRI, Dr. Cheatle was still not entirely upfront with his own family. But they noticed changes in his behavior, including staying in his car longer after arriving home from work because it hurt to get up, and having to excuse himself to go lay down. 

Ultimately it was conservative therapies, including spinal injections, that helped Dr. Cheatle reduce his pain and begin to recover. It was at this point that he was able to reintegrate exercise into his life with the help of physical therapy. 

The experience has made him a better doctor, allowing him to provide more meaningful support and encouragement to patients during the healing process. He emphasizes that the emotional aspect of recovery is often as challenging as the physical.

💡 Featured Expert 💡

Name: Joseph Cheatle, MD

What he does: As a board-certified neurosurgeon at Carolina NeuroSurgery & Spine Associates, Dr. Cheatle, provides adult neurosurgical care. His clinical special interests include treating brain tumors, degenerative spinal disorders, transsphenoidal surgery, and spinal cord stimulation.

Company: Carolina NeuroSurgery & Spine Associates

Words of wisdom: “I'm a better doctor, for sure. And what I mean by that is that I can sympathize and not empathize.”

Connect: Website 

⚓ Anchor Points ⚓

Top takeaways from this Back Talk Doc episode 

• You should be a patient, not a doctor for yourself. After realizing the severity of his situation, Dr. Cheatle sought professional help from the physical therapy department. He completed a thorough examination and underwent an MRI. 
• Don’t immediately jump to surgery as a solution. A discectomy would likely have provided quick relief. But even as a surgeon, Dr. Cheatle recognized the importance of trying other therapies first. He opted to explore more conservative treatment options before considering more invasive measures.
• Distinguishing between sympathy and empathy. Dr. Cheatle says that he is a better doctor after his injury. It allowed him to connect with patients on a deeper emotional level. By sharing his patients own struggles and triumphs, he can better relate to patients undergoing difficult situations. 

⚕️ Episode Insights ⚕️

[04:28] Brushing off an injury: Dr. Cheatle shares how he was involved in a skiing accident that he originally brushed off — before realizing it could be something more serious. 

[08:45] Discovering new humility: Dealing with an injury of his own made Dr. Cheatle more compassionate towards his patients, as he could more directly relate to the pain they were feeling.

[10:14] Asking for help: After attempting to deal with the injury on his own, Dr. Cheatle sought our professional assistance for his recovery including physical therapy and an MRI. 

[11:16] Phenomenal physical therapists: For those looking to learn more about physical therapy and neck pain, Dr. Lakhia mentions additional podcast episodes on Thoracic Outlet Syndrome and neck pain. 

[12:51] Did you get a piercing?: Dr. Cheatle and Dr. Lakhia discuss battlefield acupuncture, which uses small needles that can resemble ear studs. You can learn more in Episode 65 of Back Talk Doc on Battlefield Acupuncture for Pain with John Howard.

[15:03] Practice what you preach: The doctors discuss why non-operative care can be the right choice for people and why in his case, Dr. Cheatle decided to opt for conservative therapies first. 

[18:07] Finding relief: A series of spinal injections administered by Dr. Lakhia did end up providing some relief. Dr. Cheatle shares his experience being on the patient side of the procedure for the first time. 

[23:58] Building strength through pain: Reintegrating exercise into your routine is an important part of recovery from an injury. A healthy way to do so is discussed in more detail in another episode on Back Pain and the Sacroiliac Joint with Tanner Holden, PT.

[28:27] Addressing the questions: Dr. Cheatle and Dr. Lakhia address questions from the audience, including what can be done to address severe pain, how to treat recurrent pain after surgery, and why pain can flare up in the morning. 

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👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode Empathy and Compassion: The Journey from Spine Patient to Provider with Physician Assistant Lindsay Howard

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Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at CNSA.com.

Welcome. You're listening to Back Talk Doc where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery and Spine Associates, where cutting edge nationally recognized care is delivered through a compassionate approach. This podcast is for informational purposes only and not intended to be used as personalized medical advice. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.

All right. Hello. Good afternoon. Welcome to a very special 74th episode Back Talk Doc Podcast. For those of you joining us out there on Facebook and Instagram who don't know who we are, again, my name is Sanjiv Lakhia and I've been helping run this podcast for over four years for Carolina Neurosurgery and Spine Associates.

Today is a very special episode where we are going to, of course, be posting this to iTunes, but we're broadcasting live and we think it's a great topic and want to get some real genuine feedback from those of you who are listening. So thanks for tuning in. And I want to welcome my friend and colleague, Dr. Joseph Cheatle. Welcome to the show.

Thanks, Sanjiv. I'm glad to be here.

I bet you didn't realize, almost four years to the day, you and I sat down and we recorded the third episode of Back Talk Doc, which was a discussion about lumbar stenosis. And to this day, it remains the most popular downloaded episode. So congratulations to you.

Thanks, man. I do point that out a lot actually.

And of course, we're here in November of 2023, coming up on Thanksgiving, and I want to start the episode by giving a lot of thanks and gratitude to all those people out there who have downloaded our podcast, shared it with friends and family. Our mission here has been to really just spread good information, spread the word about spine care and the treatment options, and it's really exceeded our expectations. So from me and all of my partners, to all of you out there who are following the podcast, we want to say thanks.

And again, if you haven't subscribed, give us a like, give us five star review on iTunes, and most importantly, share it with family and friends. It's just been a real delight to be able to offer this content to you. Our last episode, if you haven't had a chance to listen to it, I recorded it with Lindsey Howard, one of our PAs, and we kind of shifted gears into more of a testimonial where she talked about her challenges with scoliosis growing up and how it impacted her decision to become a physician assistant.

And today we're going to keep with that theme. As you guys don't know out there, but we work together in the office and we're very, very close and we treat patients collaboratively, so we're able to also watch our own personal lives unfold. And guess what folks? Physicians, we are people too. We are human beings, and we have our own challenges personally health wise and otherwise.

And today's topic is I want to thank Dr. Cheatle for being willing to sit in the hot seat and we're going to talk about his own challenges with his low back that he went through really spent over the last year plus, right?

Almost exactly a year now.

Yeah, yeah. Before we dive into that, your own story, introduce yourself again to those who aren't familiar with who you are. Tell them where you trained, where you work, what you do.

So I'm one of the neurosurgeons here at Carolina Neurosurgery and Spine Associates. I've been here now four years, which is crazy. I trained in Nebraska, which hey, Panther's coach is in Nebraska now and we won our game last week, so I'm feeling good about that. But I'm a general neurosurgery. I do both brain spine and peripheral nerve here, and we treat just generalized neurosurgery down here, mostly in Rock Hill in the South Charlotte region. That's me.

And you are one of the busiest surgeons in our practice, one of the most loved and well respected. And I think it's been a real privilege to be able to work side by side with you, but it's also been real enlightening to see how you've had to deal with your own challenges. So folks, we are doing this, this is our first go live here, so hang in there with us. I would also say there is an ability to post your questions and comments as they come up, and we'll get to those as they come in or towards the end.

Start from the beginning, Joe. I remember you were in a lot of discomfort. Why don't you walk people through the beginning of your journey dealing with your own back?

Doing this right, I mean, I've done this now for almost 15 years between training and going through residency, which you work terrible, long hours. And then as an attending, which you work terribly long, more hours. And so I figured that if I ever had something like this happen, I'd be able to diagnose it really easy. And it was really hard to diagnose this. It was a really big challenge. So I first got hurt. It was right after Christmas, and we were at this little ski trip up in West Virginia.

And I was on the side of the mountain and my small child was coming down behind us, and then a guy lost control and just completely smashed into me. And I went flying. I'm sure it was really funny for everyone else to see, but it was pretty uncomfortable. I said a few things that I shouldn't say in front of my children. I was a little bit frustrated, but I got up, kind of went on during the day, hurt a little bit in the back, but not bad and just started, didn't think much of it. We came back the next day.

I was stiff, but we were in the car for six hours driving on those curvy roads and didn't think much of it. And then really honestly, to be overly personal, my butt hurt. I was like, "Wow, gosh. I mean, what happened?" And I was really working out at the time and I was really trying to gain muscle mass. It didn't work much, but it was something that I was really into. And I was like, well, maybe I just overdid it and maybe thought I had an ischial tuberosity tear, or did I bruise something?

Maybe I fell down weird. And so for the next couple weeks, I just was like, "Ah, my butt hurts a little bit. No big deal." Kind of backed off a little bit, but not a ton and just limped through. And then it just progressively got worse and worse, and it was really centered low back down the leg a little bit, but not in a true radicular pattern. And so I've always been that practitioner that looks back and is like, "Hey, pieces don't fit. Let's keep looking at things and understand." And you know that.

You've been in that situation where you're like, "it kind of seems like this, but it's not perfect. Let's look at things a little bit more." But for myself, I was like, oh, it's definitely not a lumbar radic. I know for sure it's not my back. It can't be," because I didn't want it to be, right? Denial is just that thing.

Well, look, I'll interject here. A couple of things that y'all need to understand about docs. First of all, when we have any symptoms, we know too much, so sometimes we'll think the worst. And my wife will often be like, "No, it's not that. You just pulled a muscle, or it's just a cold." So there's that that we'll deal with. And then the flip side of that is what you just said. When you know something ain't right, sometimes, at least for me, I'll go into a little denial mode.

Yes.

And then also, I've talked about this before, when you're a spine physician, spine surgeon, having a spine problem, for me, sometimes it feels a little shameful. I'm not supposed to be that guy. I'm the expert. I run the podcast. I do these things, and I hurt my back. I don't know. Did you have any sense of that as well when you started to realize that was going on?

100,000%. In fact, I actually pulled over one of our other physiatrists one day in clinic because I was just miserable. Even getting out of the car, I looked like I was 90. I mean, I would limp. And I pulled him over and I went and shot X-rays on myself. And I looked at the X-rays, and I knew that there was discogenic changes at L5-S1, which I mean, not to divulge too much of foreshadowing here, but I had a disc herniation, L5-S1 and I looked at it and I was like, "Oh, it looks fine."

And Vemuri was like, "Dude, you got some changes there and it looks like it's a little bit eccentric to the left. And I was like, "No, no, it looks fine. It looks totally fine. Don't save those pictures," I said then to the radiology tech, and she's like, "What?" And I'm like, "You don't need to save." She looked at me and I just didn't want to admit that something was wrong. You know what I mean?

So this is where I think the transition began for you, oh my gosh, I'm a patient.

Yes.

Right? Talk about from a patient side. You're a dad. You're very active in your social community or church community. Just as a person who's realizing you're dealing with a pretty serious back injury, what were some of the emotions that you felt initially

Humility, and that's the hardest part about being... Neurosurgery I think. And this my junior resident or my senior resident when I was a junior resident said this, is neurosurgery is the most humbling career on the planet, right? Because even if you are at the top of your game, it's still impossible to be perfect. You just can't because it's neurosurgery. You do the best brain tumor in the whole world, but it's still a brain tumor. You don't win every time, so to speak. But you just got a different humility because not only is it depersonalized, it's uber personalized.

It's you. You can't be like, "Well, it's okay. You did the best you could." I mean, it's you. It's just different, and it was different in the fact that I thought of every patient all at once. And I'm like, man, I know exactly what they're going through. And it's different to be in that spot. It made you so much more compassionate, even though I feel like I'm a pretty compassionate person at baseline, literally every patient after that, I was like, I know exactly what you feel. Bro, it's terrible. It sucks, right?

No, for sure. One of the purposes of sitting down and talking with you that I was hoping is for those of you guys following, I want you all to understand some of the lessons that you can learn going through an injury. And then also though, just how did an expert like Dr. Cheatle handle it? So what were some of your initial strategies to start to work with the pain? What was your thought process on how you're going to get this treated?

So to be honest, I treated it just like everybody else. I knew exactly. I was like, "Well, I know what to do. This is easy." The answer from where to go from here is easy. So I went to go see our physical therapy department. Jay at Ballantyne is where I was that day, and I walked upstairs and found Jay. He's spectacular, by the way. Not that any of our therapists aren't amazing. And he sat down with me. He did an exam on me, a really good thorough exam, because I had been kind of doing this on the side, which is totally inappropriate. And he did all the stuff that you're supposed to do.

And I quit treating myself. I asked other people to start doing things, because before that I was doing my own thing. I was like, I send in the Medrol dose pack for myself and stuff that you're not supposed to do. I mean, it's not illegal, but you did not supposed to do that. You should be a patient, not a doctor for yourself. And so Jay did an exam. He was like, "Yeah, dude, I think you have a lumbar radic." And then I got an MRI scheduled. I did therapy, got an MRI, and then I came to you. I said, "Sanjiv, I need help, man. There's something going on."

If you guys haven't heard Jay Murugavel's podcast that I recorded with him, he's one of our phenomenal physical therapist, and we did a collaborative with him and Emily Tucker about thoracic outlet syndrome. Another shameless plug. He mentioned Dr. Vemuri, and I did a recording with him on neck pain. And we'll put links to all this in the show notes. But so what you outlined is the conservative care pathway. And at Carolina Neurosurgery, we have a huge staff of physiatrists and physical therapists.

And I think a take home point here is most of these acute disc issues can be treated and improved without surgery. And at a minimum, that's typically what's attempted upfront before you go to the surgical route. So when you came to see me and I could really tell in the office that you were just gutting it out, a lot of pain, but you were still working through it. And I was just saying, "How can I help him? He's my brother. He's my partner. What can we do?" And all the options are on the table. You knew them. If I remember, we tried a little bit of battlefield acupuncture.

Yeah. As a side note, that stuff's amazing. And the funny thing is, I didn't tell my wife. So I went home, you leave little needles in there. And she's like, "Did you get a piercing?" And I was like, "No, I got acupuncture." She's like, "Why?" And I wasn't honest at home either, to be honest with you.

I was trying to gut it out, as you said. So I wouldn't complain as much. When I got out of the car, everyone noticed because I would just stand there and I couldn't move. But I wasn't at home telling my wife and kids, "Man, I'm miserable." I'd be like, "I'm just going to go lay down for a little while," which is very unusual for me, by the way.

It's unusual. In the office I could tell because you were quiet.

Yeah.

You were doing your work. I mean, no one could really tell, but I know you and you were quiet and I could tell you were suffering. The battlefield acupuncture, Hannah, we're getting a lot of posts and questions that we can't see, so let us know if there's something that really needs to be jumped on. But battlefield acupuncture, he referred to a few things. That's the technique where I utilize some very small... They're almost like earring studs. They're ear needles. It's a form of acupuncture for acute pain control, and we put the needles in certain spots.

We leave them in for anywhere from 24 hours up to a week, and it really can help shut that down. And if you want to learn more, I did interview one of the founding fathers on battlefield acupuncture, John Howard, and we'll link to that one in the show notes as well. So we did that of your work and your physical therapy. We looked at your MRI, and I think the first decision that you had to make that I'm really curious to hear your thoughts because you're a surgeon. When we looked at your MRI, you basically said, "I don't want surgery."

Yes.

So I found that to be a little bit hilarious. Sometimes if you're a hammer, everything's a nail. We've heard that before. But you looked at the MRI and you said to me and yourself, "I don't want to have surgery if I can avoid it." So I want you to tell the people out there what was behind that line of thinking.

To be completely honest, is I think when you're in pain, you jump immediately to, how can I get better right now? The first thing is, what can get me better? And I know a discectomy would get me better. No doubt in my mind a discectomy would get me better, but I knew it were me sitting there talking to you, which I've done before, I'd be like, "Don't do surgery." You need to do all the conservative therapy first because we know that that works.

It's not there because people are like, "Hey, let's torture you for an extra six months." We know that most people get better with conservative therapy. And I could have easily gone to one of my partners and, "Bro, I need surgery," and they're like, "Hey, we need to keep you productive. Let's get you on surgery. Let's get it done tomorrow," and I could have just done it and just got it done.

I mean, I felt like that took a lot of courage as a surgeon to practice what you preach in terms of getting patients to go down the conservative care pathway. And it's not necessarily, in my opinion, as I do this longer, I don't look at things as right or wrong anymore. I just ask myself, what's the next best thing for the person in front of me? I mean, you and I know the treatment algorithms. We know all the great treatments. We have phenomenal surgeons. I mean, we have some younger surgeons, even Vince Rossi just gave a great talk recently on artificial disc.

I mean, there's some phenomenal spinal surgical technologies that are emerging. But at the same time, we also know that the data shows a majority of people, if they don't have a serious neurologic deficit, can do pretty well with non-operative care. So I would not have faulted you, Joe, to be like, "I'm calling up Mark Smith. I'm getting this done on Saturday, and I'm going to be back to work on Friday and this problem is going to be behind me."

I mean, certainly you could justify that if you wanted to go that route, but we didn't. And then you went through a couple of injections in the back.

Yeah.

Again, those are probably your first spinal injections, right?

Oh, by far.

By far. So what was it like to be on that side of the needle?

Terrifying. I was terrified. I mean, we're friends, right? There's no doubt. And so I know things can happen, and the risk of that is I'm more at risk of getting a car accident on my way to work than I am at risk for an injection. I know that, especially how I drive. The long story short is, I mean, I knew that the risk were super low. I'm a pretty healthy person. I don't have any bleeding discourages. No big deal. But I was scared. I mean, I was cold sweat.

My hands were freezing. You know when you get that. It was terrifying. Yet I was really good at being like, "Oh, yeah, I'm fine." And Krista, our MA, she's like, "Hey, how are you doing?" I'm like, "I'm doing great." Then she tested my blood pressure and I'm 165 over 92, which I live at 110.

This was before I put the needle in, folks. I didn't cause that.

And so the funny thing was is you get put on a pulse ox. I look at my pulse when I'm doing these things and I'm like, "Don't go above 60. Do not go above 60." And the funny thing is you commented afterwards, because you're doing the injection, the first one. So I ended up having two injections. And so the first one and you were like, "Your heart rate didn't go above 60." I know, and I just wanted to be like, because I was willing to not go above 60. But in my mind, I'm going 1,000 miles a minute. It was great. Maybe a second of a twinge of pain, and I felt nothing. I was like, this is awesome.

Well, for my integrative friends out there, you'll appreciate that I was doing a little bit of my 4-7-8 breath work before he came in the room. That's four seconds of deep inhalation. You hold the breath for seven. You breathe out for eight. It shifts you into a more parasympathetic state. I was like, get relaxed. You've done a million of these. No offense, he's just another patient. That's what I had to tell myself. The procedure went great, obviously. Do you think it was helpful in retrospect?

Oh, for sure, the second one especially. So the first one helped. It didn't help that much. But then we did a second injection about a month I think it was later. That wasn't as easy because for some reason you kept getting into a perineural vein. And I'm sitting there staring at the screen and I know what I'm looking at. And the funny thing is Sanjiv is sitting there and he's like, "Okay, so now we're going to go and look at the S1." I'm like, "Yeah, I know," but it was super relaxing.

And I'm sitting there and I'm like, oh yeah, for sure. And we're good. And then just relax. It's all good. And then afterwards, you feel it down your leg a little bit. Not bad. A couple of days later I was like, I'm better. Now, I'm not perfect. I wasn't perfect immediately, but I was like, I'm better.

Improvement.

And it wasn't one of the things where... I have patients that be like, "I was 100% better the next day," and I was like, "Wow, I'm jealous." But then each week I was like, hey, I can sit in my car now. You know what I mean? And then I'm like, hey, I can get out of my car without hurting. It was definitely improvement.

Dr. Cheatle had a condition where the nerve was pinched from the lowest disc. It was contacted. And that nerve, when it's flared, goes right down the buttock, back of the leg into the calf and sometimes the foot. So I know a lot of you out there can relate to that, and it can make you feel like your buttock is going to explode where you have a constant cramp in your calf when you stand or walk. So the first step to healing from that is trying to get those symptoms out of the leg and centralized into the hip and back, because then you can walk and move and start to exercise some.

So that was a big hurdle that you overcame. I don't know if you remember this, but you printed off and brought to me a research article on the natural history of disc herniations to support that, hey, this is going to get better. Share with people if you can recall what that article was a little bit. Do you remember that?

Yeah, I do. Oh, for sure I do. It was actually pretty new. It was funny how it came out.

It was. It's hot off the press. Hot off the press.

And it was looking at disc morphology and the potential for improvement. And with acute disc herniations, I think it was like 74 or 76% or 70 something percent actually get better on their own with conservative therapy. Actually, if you repeat the MRI at a year later, that their disc herniation is appreciably and statistically significantly smaller than it was at that time. Again, the big thing was it had to be an acute disc herniation, right?

Yes.

And those are more common in middle-aged people, like the most elderly of our patients, although they can happen to them too. But these either young 20s, 30s or middle-aged, 40s and 50s who have these acute disc herniations oftentimes get better without surgery, and they're sometimes the ones that we rush to surgery because they're at that age where we're like, hey, we got to get them better faster. They don't have the patience to get through that conservative therapy. I've had this conversation with some of my physician colleagues who have come to me after I've had this.

I'm like, "Bro, no, no, no. We're doing an injection," and they're like, "But." I'm like, "No, no, no. I'm not giving you the paper." I'll hand that paper out to them and they're like, ooh, ooh. And they get better, and then I'm like, "I told you." You know what I mean? So it came out just to reassure me at that time, which was super convenient.

That was a sign for you. Now, start to walk people through, you're starting to feel better, not perfect. What was your approach to reintegration into your active lifestyle? You're super active. I know before this you had a trainer. You're really into running, weightlifting. How did you approach the let's get myself back to where I was without having a setback?

I had to lean on Jay again. I talked to our physical therapist again, went back up there for a couple more sessions. He gave me exercises to start, like bird dogs. You use the exercise ball and just started all that stuff again and just slowly increased it. And then started to get back to... I would first start with walking. When I would go for a run, instead of the run, I'd go on a good long walk. And I try to increase the pace until I could jog a little bit, and then I would... So there's no definition of jogging versus running. If you try to look it up, it's not real. But I would do for me was a slow run.

There is a definition. If I'm doing it, it's definitely jogging. The running days are over.

But the other thing that I did too was I started getting on the stair climber, and we talked about this too is that I tried to do something that was like it works me, but I'm not having the pound that you get with the run. And the stair climber did that really well for me because it didn't hurt my back. I could stand up straight, so I felt really comfortable and keep my core straight.

But I did breathe really hard. So I knew that I was working hard and it helped rebuild that strength. Because although I had no clinical weakness, it just didn't feel as steady underneath the feet. You know what I mean? And that helped a lot.

For sure. What about your approach to weight training? Because I know you were doing some squats. You were really into muscle building and really just trying to build up your strength. So how did you modify your approach in that regard?

So when I was hurt, for the first couple of weeks, I still was going full on without backing off at on weight training, which was not the smartest decision retrospectively, but I thought I had pulled a muscle. And so it convinced myself that I'd pulled a muscle. So I thought, hey, I'll just keep doing this. And the funny thing is, it didn't hurt at all when I was training. I was dead lifting. I was squatting. I was like, this feels great. That afternoon it would hurt and I would be like, oh, it's not related.

It totally was. But the long story short is that I backed off a little bit, but now I'm back. I mean, I did dead lifts this morning. I've been a little bit more cautious about how much weight versus how many reps I do. Because I'm almost exactly a year out now for my injury. I'm not back at the same weights that I was, but it's not that I don't think I could lift it. It's just that I'm like, I don't think I need to be as gung-ho on weight. I still do it. And so it's definitely enjoyable still.

That's a good point. I used to lean a little more on when you're hurt to pull back from exercise in that phase. But in my own work with our own physical therapist here, Tanner Holden, who again, we did a podcast with him on sacroiliac joint pain. So listen to Tanner. He really taught me about building strength through the pain or working around your limitations. I really underestimated how weak we get when we have these acute flareups, whether it's your back, your knee, you're hip.

You just stop moving. And an old adage in physiatry world is that every day you're immobile, that takes two days of exercise to build back what you lost. And it's such a consequence when you have these acute flare-ups. So I think letting go of some of the fear of movement is as much a hurdle as overcome the physical pain. A lot of patients, myself included, and you might've experienced this in the past, when you recover from an injury, there's always just like, oh no, is it going to happen again if I do X, Y, or Z?

And that's a huge psychological hurdle that probably for me the best way to get over that is working with a wonderful physical therapist.

For sure.

They can help you break through those fear hurdles when you can't do it on your own. That's awesome.

One thing to say, I think I learned that too, but I've seen that adage that there's almost no injury that needs rested. You need to modify, and that's different than resting it. So it's not like a sprained ankle where you rest the ankle, but you still keep doing stuff. That's one thing that I kept. I did a ton of upper body stuff. I kept doing stuff. And then anything I could do without pain, I just kept doing it. I just kept on the stair step and I even got back rowing, I think. For me, rowing feels great on my back. And so I was getting back into rowing, especially if you do it right.

If you're watching and you've had an experience like that, put it in the comments about when you've had an injury and some of the things you've done. Was it the elliptical? Was it the rower? Was it walking? What helped you stay active while you were on your healing journey? Now, this has been really good. We've covered a lot I think from your injury to the different treatments. Let's talk big picture. How did this injury change how you practice and take care of people?

I'm a better doctor, for sure. And what I mean by that is that I can sympathize and not empathize. So sympathy is when you've experienced the same thing that someone has. So if you're like, hey, you lost a dog, and you're like, oh my gosh, that's terrible. I've never lost my dog, but that sounds like a terrible experience, versus, "Hey, I lost my dog. It was hit by a car," and you're like, "Mine too. I can feel that pain in the same raw way that you feel it," and that raw emotional pain. Because I mean, everything that happens to us has an emotion to it.

We're emotional animals, and so we have that raw grit that you're like, "I went through that experience and I went through that. I got through that too. And it sucks some days." And I get why sometimes I'll have patients that are like, they're like, "I'm not doing right," and you're like, "No, you are. This is why you're doing and this is what you're feeling. I felt that too." And they're like, "You did?" I'm like, "Yeah, yeah, I know what you're feeling." And I'll be like, "Yeah, it sucks to get out of the car, right?"

And they're like, "Yeah, it's really hard." I'm like, "Yeah, it's hard. It gets better." And I would have to stand on one foot and stand there for about 30 seconds before I could put my weight down. I'm like, yeah, I get that. You know what I mean? Yeah, I feel you. Different than saying, "Yeah, it can be flexion sensitive, and yeah, it hurts to get out of a car." And you're like, okay, that's very clinical. You know what I mean? And so you can connect in a different way. And so it's not that I treat people any differently than I ever would, and I always tell people that I treat them like my own family.

I mean that. But at the same point in time, I can feel that struggle and that struggle sometimes is what a lot of people struggle to get over. It's not the actual injury. It's that emotional response that you have and that difficulty getting everything in life to work with you because you have to change everything.

You have to change everything. I think having the injury, it allows you to validate people's concerns on a deeper level, and you get a little more credibility. All right, so we've got some... Hopefully this has been good for y'all. We've got some comments and questions coming in.

We've gotten a lot of really positive feedback. Just again, some sympathy for Dr. Cheatle. People live your same spot, but we had Craig say, "What can possibly be done for severe pain?"

The world's hard because of the narcotic crisis and it's a bad situation. And for me, I felt really strong that I didn't want to let my patients down. So I was absolutely 100% non-narcotic the entire time. So I did Neurontin. I just started that on my first weekend that I was off. I did Neurontin or Gabapentin, and it didn't affect me from a mental standpoint. Some people, it can make them really tired.

I didn't feel that. I did some NSAIDs, and then I did prednisone as well. For me, I was lucky enough that I didn't have any significant pain when I was standing and you stand up for surgery. And so I was able to do my job without pain. It was really getting to and from my job and then being at home, eating dinner or sitting in church.

I remember you said getting in a car or sitting in the car.

Terrible, which didn't affect my patient care. If it were to the point where I couldn't do my job right and my pain was not under control, sometimes you have to do narcotics, but I really think that doing non-narcotic therapy is really, really maximized, that if at all possible. I pushed that as hard as I could.

No, I definitely agree.

So Kim said, "With my thoracic outlet syndrome, the foam roll helped my neck and arm pain."

Yeah, soft tissue work is underrated even with lumbar radiculopathies. And for those who aren't scientific, when we say radiculopathy, we're referring to nerve compression syndrome with pain that travels down the extremity with some associated weakness or numbness. Even with a pain syndrome that we know the origin is in the spine, you can get significant benefit through soft tissue work.

So a foam roller where you're rolling out your IT band, rolling your hamstrings, using a tennis ball or a small rubber ball to get those deep buttock trigger points. Because what happens is when the nerve is inflamed, all the muscles along the pathway get hyperactive and sensitive. So there is a way to help calm that down. Thanks for that tip. That's a really good tip that people can use.

I did dry needling as well with e-stim. It was awesome.

Someone from Instagram said that may not be a realistic option for people with severe pain.

Yeah, unfortunately, yeah.

That's a good point. I mean, if you have a highly sensitive acute pain syndrome, it's probably not going to feel good to be doing deep tissue work on it.

That's I think where the therapist was helpful too. They could really assess, and they looked at what was going on and started slow and worked up from there too.

Kathy on Facebook said, "Is decompression for your neck okay to have before you have a cervical fusion?"

That depends. I think a lot of that depends on the situation. What is the structural abnormality on your imaging study? How much space is in the spinal canal? Who's doing it? So that's a great question probably to talk to your surgeon or physiatrist about before you engage that.

Ken from Facebook said it's been a little over a year since his surgery. He's having similar pain again. Should he start PT again? L5-S1 surgery.

Okay, so the question was about recurrent pain after surgery a year after. You want to run with that?

Yeah. I mean, the hard part is is that unless you had a fusion where you take out all the disc, you can herniate those discs again. So physical therapy usually is pretty safe to start. It really depends on your symptoms. The big thing is is that I was lucky enough not to have significant weakness, bowel or bladder problems or really significant numbness.

Those are the red flag signs that you really got to look at, and that's when you have to get back into your doctor before you go to physical therapy. If it's just pain, it's pretty safe to start with therapy. But again, I would probably clear that through your treating surgeon.

All right, we have another Instagram viewer said, "I have the most pain when I wake up in the morning and I go to sleep feeling good. But when I wake up, I'm feeling awful. Are there any suggestions? The pillow between my legs has really helped. It just really helps."

Okay. I'll repeat the question just in case they can't pick it up from you, Hannah. The question was about or just around the idea that increased pain upon awakening. One of the things to consider, at least how I look at this problem, we know that our lumbar discs, they swell a bit at nighttime. They rehydrate. So having that nocturnal pain and that pain upon awakening is fairly common and it does tend to improve as you move about.

Sleep positioning is key, but there isn't good data on the optimal sleep position. So it depends on the type of disc. Some people actually do well if they sleep on their stomach because the extension helps. Some people do better with the fetal position, the pillow between their legs. Do you have any tips for people on that?

I don't know how anybody sleeps not in the fetal position, but that's a different story. But yeah, I mean, I think it depends there too. The other thing is is that you're probably not medicated by the time the morning comes too. So you may have taken some non-steroidals or something like that and then that's worn off. That helps there too.

Sometimes that I've told patients if they have really bad pain first thing in the morning, I tell them if something like a non-steroidal does help, like a Tylenol or Advil, set an alarm, take that 30 minutes before they're supposed to get up, so it has a time to work in. That can be helpful. And then other than that, just try to give yourself enough time in the morning to work through that routine to slowly increase that because it does hurt. Oh man, it hurts.

Just a disclaimer, again, we are doctors, but we may not be yours. So this is information only and really encourage you to speak with your medical team or come see us at the clinic and we'll be happy to give you some more customized recommendations. All right, so this is awesome. Thanks again for your time.

Thank you.

I think there's a lot of lessons to be learned. One of the lessons that I've learned is that as much as we like to feel like we're in control, we're really not. So particularly in the world today, being willing to roll with things and then be willing to ask for help, and that's what you did. I really commend you on doing that. And I wish you many, many years of healthy spine and healthy active lifestyle and long career and working together. So thanks for your time.

And that's partly to you, Sanjiv. I appreciate you, man.

All right, buddy. Thank you.

Thanks, buddy.

Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.