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A Neurological Approach to Treating Pain with Garrett Salpeter of NeuFit
Episode 3710th December 2021 • Back Talk Doc • Sanjiv Lakhia - Carolina Neurosurgery & Spine Associates
00:00:00 00:38:32

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Being told your pain is only in your head is maddening when it’s your back that hurts. But is there more truth to this statement than we have long believed?

NeuFit founder Garrett Salpeter says that pain is sometimes not an accurate depiction of the extent of an injury, but rather an overreaction by your nervous system.

At NeuFit, Garrett draws on his background in engineering and neuroscience to help athletes and other patients recover from injury, develop sustainable fitness regimens, and improve their overall health.

Garrett joins this episode of Back Talk Doc to explain why his unusual approach to treatment acknowledges the structural focus of traditional pain management, but operates within a neurological framework.

“There is this very important common thread… from early-stage rehabilitation all the way through general fitness and elite athletic performance, and that is the nervous system,” Garrett says. “It controls so many things about us: How we heal and recover from injuries, how our muscles work and move, whether we experience pain or not.”

Garrett also created a new muscle stimulation device, the Neubie, that combines the alternating current traditionally used in these devices with direct current, to maximize relief. In addition to using it with patients, he relies on it to optimize his own workouts.

Listen to this episode of Back Talk Doc to explore the intersection of neuroscience, engineering and physiology, and how it can offer a holistic approach to treating pain.

 

💡 Featured Experts 💡

Name: Garrett Salpeter

What he does: Garrett has studied engineering and neuroscience. From this unique vantage point, he leads neuromuscular therapy provider NeuFit, which is dedicated to treating athletes and patients, helping them reach their fitness goals and heal from injuries. He also hosts The NeuFit Undercurrent Podcast and is the author of “The NeuFit Method: Unleash the Power of the Nervous System for Faster Healing and Optimal Performance.”

Company: NeuFit

Words of wisdom: “If someone comes in because they ‘threw out their back’ …  in that really acute spasm-like state, a lot of times there’s some minor insult or something like that, but the reason that they’re in such pain and they’re so debilitated is because of the neurological overreaction.”

Connect: LinkedIn

 

⚓ Anchor Points ⚓

Top takeaways from this Back Talk Doc episode

★    Examining your pain within a neurological framework offers advantages over a traditional approach. The traditional approach to treating pain tends to lean heavily on structural explanations: If your back hurts, there must be something physically wrong with it. Instead, focusing on your body’s response to an insult as a neurological overreaction that creates pain (without discounting the possibility of a structural issue) may be more effective.

★    The body’s protective responses to stimuli are necessary, but often an overcorrection. When Garrett and his team identify a defensive neurological reaction to an insult, they are careful not to eliminate it completely, because it serves a purpose.  Yet the response is often too far-reaching. Many times, this has to do with bad habits that a patient has developed in the way they move their bodies, so treatment is usually more a matter of recalibrating the response than getting rid of it.

★    When it comes to muscle stimulation, direct current is worth a second look. Direct current fell out of favor among pain specialists decades ago. Despite its therapeutic effectiveness, it burned and stung the skin. To address this and harness direct current’s power, Garrett developed the Neubie, a device whose proprietary waveform feature uses alternating and direct current.

 

⚕️ Episode Insights ⚕️

Top takeaways from this Back Talk Doc episode

[00:00] Mobile-based solutions for clinical practice: Check out our sponsor, QxMD, which builds mobile solutions that drive evidence-based medicine in clinical practice.

[02:01] Meet Garrett: Garrett Salpeter is the author of “The NeuFit Method: Unleash the Power of the Nervous System for Faster Healing and Optimal Performance.” He founded neuromuscular therapy provider NeuFit, and also hosts The NeuFit Undercurrent Podcast.

[04:59] The common thread:  From general rehab patients to elite athletes, the nervous system is the key differentiator when it comes to controlling how we recover, move, think and feel. It controls our muscles, hormones and pain responses.

[6:10] Tip of the iceberg: Often when a patient comes in complaining of an acute injury, the real reason for their pain, even if they have suffered some minor injury, is the nervous system’s overreaction to it, e.g. a back spasm.

[6:59] A different paradigm:  Instead of focusing on the affected structures, Garrett and his team focus on the neurological responses to injuries. They do this by identifying where the brain and nervous system are activating those responses, and stimulating those areas to reset, recalibrate and reeducate the response patterns.

[9:02] First things first: This is a different framework but not a substitute for considering real physiological issues. Before investigating a patient’s neurological responses, NeuFit checks to make sure there’s nothing structurally wrong with them.

[11:32] Root causes: When patients experience pain from certain types of movements or extensions, it’s often because certain muscles are shut down or inhibited.

[13:01] The strength within: By measuring and mapping pain and then focusing on root causes, NeuFit helps people tap into muscle they already have but are preventing themselves from activating.

[13:57] Hyperfocus: In addition to manual muscle testing, NeuFit uses electrodes that send direct currents to identify the protective responses the patient is exhibiting.

[18:49] Next-level muscle stimulation: NeuFit’s proprietary device, the Neubie, uses direct current stimulation to communicate with the nervous system precisely and efficiently, and alternating current to provide comfort during muscle stimulation.

[25:37] Balancing it out: NeuFit’s treatment process determines how much of the body’s neurological response is necessary, and how much is an overreaction to a perceived danger. 

[27:54] More function than form: Garrett has seen people make more progress by emphasizing function over structure.

[31:05] Sweeter dreams: Using the Neubie in conjunction with his workout regimen, Garrett has significantly improved his quality of sleep.

[37:08]  What he’s reading: Garrett recommends “Head Strong” and “Super Human” by Dave Asprey.

 

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👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode The Art and Science of Trigger Point Treatments.

For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

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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 carolinaneurosurgery.com.

Transcripts

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Intro (:

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 providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years. 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.

Sanjiv Lakhia (:

Welcome everyone to Back Talk Doc, another episode here where we are passionate about educating you on everything related to back pain. For those joining the show for the first time, my name is Sanjiv Lakhia, and I'm a board certified physiatrist, so specialist in physical medicine and rehabilitation. And I work at Carolina Neurosurgery and Spine Associates in Rock Hill, South Carolina in the office in that area. And I have just been really on a mission of the last year, year and a half, to help educate the community regarding all the options to take care of your back, largely from this is who I treat, and actually, I've had my own issues in the past, so it's very personal to me. And this is a labor of love to help you overcome whatever you're challenged with.

Sanjiv Lakhia (:

And throughout this journey, I've had the privilege and pleasure of interviewing so many good guests on the show. And recently, got contacted by Garrett Salpeter, who is the author of the book, The New Fit Method. He expressed an interest of coming on the show and sharing the good work that he's doing down in Austin, Texas. So Garrett, welcome to the show.

Garrett Salpeter (:

Thank you, Dr. Lakhia. It's a pleasure to be here. And I love what you're doing and excited to be a part of it.

Sanjiv Lakhia (:

Fantastic. Now did I say your last name right? I should've asked that before we came on.

Garrett Salpeter (:

You got it. You nailed it.

Sanjiv Lakhia (:

All right, perfect. Perfect. All right. Friends, so let me introduce Garrett. Garrett has put out the book, The New Fit Method. And he lives and works in Austin, Texas. Garrett's combined training in neuroscience and engineering to start New Fit. And it's a company at the nexus of neurology and fitness, dedicated to treating athletes and patients in the realization of fitness goals, effective rehab, and improve overall health. He's the host of his own podcast, The New Fit Undercurrent. And he has had many great guests that I've been able to listen to your show, it's been great. And he and his team work with thousands of patients, helping them recover from sports injuries, neurologic injuries, and chronic pain. He's treated professional athletes, sports teams, universities, and just normal average people like myself. So he is married and has two daughters, lives in Austin. Anything I left out there that you want the listeners to know about you?

Garrett Salpeter (:

I think you covered the main biographical points. I appreciate that. I think really, really, the work thankfully has grown. It's much bigger than myself or any one person, so I'm excited to dive into some of these concepts because I think they're really valuable, and hopefully will be helpful to your listeners.

Sanjiv Lakhia (:

Now you're a PT, physical therapist by background.

Garrett Salpeter (:

My education is actually engineering and neuroscience, did graduate school in both. And I work with several physical therapists. We have them on our team. We've trained and certified many hundreds of them. But I myself am not a physical therapist.

Sanjiv Lakhia (:

Okay. And it's interesting because I have an engineering background as well before I got into medicine. And I think one of the things that you look at is the body not just in small compartments, but really as a total functioning ecosystem. So let's talk a little bit about the New Fit method, which is the method that you've developed. For those who aren't aware of it, give us kind of the 30,000 foot overview of what this is.

Garrett Salpeter (:

So we often work with patients who are similar to the ones you work with, who are looking to recover from chronic pain or other injuries, whether it's back pain, or whether it's sports injuries in shoulders, knees, ankles, or whether it's chronic pain that people have had for years. We also help them restore function that they've lost because of neurological injuries or diseases like spinal cord injuries, strokes, MS, and help people build a sustainable fitness practice. And the reason I'm speaking so broadly across that whole continuum is because there is this very important common thread throughout that entire continuum, from early stage rehabilitation all the way through general fitness and elite athletic performance. And that common thread is the nervous system. It controls so many things about us, how we heal and recover from injuries, how our muscles work and move, whether we experience pain or not, and then of course, our hormones and our overall health and wellbeing, blood pressure, digestion, waste elimination, reproductive function, our thoughts and emotional status.

Garrett Salpeter (:

There's so many things. The nervous system is really the ultimate control center, control system. So working at that level allows us to have these far reaching effects. And different practices are using it in different ways, many of whom, and there's definitely a sweet spot in that physical medicine and rehabilitation world in helping people with pain and recovery from injury. And there, I think the special sauce really is in helping patients recover faster from injury and pain, or more completely because of this emphasis on the nervous system, because so many times, if someone's injured, we can talk about separating acute injury and chronic pain. So if someone has an acute injury, if someone comes in to see you because they quote, unquote, threw out their back, which is the phrase of course no one really has thrown out their back, or they'd be paralyzed.

Garrett Salpeter (:

But if they come in, in that really acute spasm like state, a lot of times there's some minor insult or something like that, but really, the reason that they're in such pain and they're so debilitated is because of the neurological overreaction that the spasms, the self imposed guarding, protection spasms, pain, that pattern of protection against the original insult. If someone bends over and picks up a pen and irritates a little bit, the spinal cord, or nerve root, or something like that, you've familiar even more than I am with the underlying mechanisms. But the basic premise is that we're shifting, instead of focusing just on the structures on the disks, or the ligaments, or whatever the structures are, focusing on the neurological response to injury, so there's two parts to that.

Garrett Salpeter (:

One is actually scanning around, mapping the body to identify where the brain and nervous system are imposing those protective patterns, where those spasms are being activated, and where the nervous system, where it's guarding and protecting in a way that's keeping that person locked in that injured, very painful state. And then once we identify those, stimulating those areas to help reset and recalibrate and re-educate that pattern. Sometimes patients will come in, in eight or nine out of 10 pain, and leave walking pain of zero, or one, or two. I mean, sometimes it's dramatic. Sometimes it's not always as dramatic. But by managing that neurological response, it leads to some pretty profound breakthroughs, oftentimes in the treatment of various injuries.

Sanjiv Lakhia (:

All right. So let's break this down with kind of a case, kind of thinking my language and the language of a lot of people who listen to this podcast. So for example, at our clinic, yes, you are correct. We get a ton of, I bent over and my back went out. Or worse, I bent over and then my leg went numb. And it does turn out that they bulged or herniated a disk. So with your approach ... Okay, backing up even further now. If you look at the traditional paradigm, which is largely what we follow, and I do myself with a lot of my patients, at least initially, is you're looking for a structural explanation. So we do X-rays, MRI studies, EMGs, and try and localize the pain generator, and then treat it, whether it's with epidural steroid injection, traditional physical therapy, acupuncture, or what have you. What you're saying though is understanding really what is the neurologic response to that localized injury. Correct?

Garrett Salpeter (:

Yes. Just because we're applying a different framework, it doesn't mean of course that we throw out physiology. Right? If there is still a structural issue that needs to be attended to, we need to attend to it. But by shifting the emphasis and focusing on once we've screened to make sure that someone hasn't lost bowel and bladder function, or doesn't have a significant spinal cord impingement, making sure that once we've screened for some of those more serious structural issues, then we know, okay, we can address this neurological response and it'll be appropriate to do so.

Sanjiv Lakhia (:

So you mentioned in your book, which I enjoyed, by the way, so thank you for sending me that, that you'll do a type of muscular screen for your patients that come in initially. So let's use the example of low back pain. What are some common dysfunctional muscular patterns that you see that people have in terms of guarding and that are supposed to be protective, but maybe when they come to you, they're at a point where they're now dysfunctional and no longer serving them?

Garrett Salpeter (:

So there's a couple things that we'd find. We have two main approaches that we use to assess people. Before we even get into our specific assessments, we would do similar things that you or anyone would see when you first have contact with a patient. We see: Can they flex? Can they extend? What movements cause pain? What's their range of motion like? Can they do those basic movements? And then when we begin our actual assessment, it's two main things we do. One is manual muscle testing, which a lot of physical therapists do on a, they'll typically use a zero to five scale. So if you are laying down, if a patient who's listening to this was laying down on a table, you'd hold your leg up. You're lying down on your back face up. And you hold your leg up, and someone, your therapist or doctor would push down on your leg, grab down by your foot, push down. You have to hold your leg up, so you'd use your quad muscle on the top of your thigh, your hip flexor muscles to hold your leg up.

Garrett Salpeter (:

And if they push down, you should be able to exert a reasonable amount of force. And then if you rotate your leg, you're going to test different muscles, more of the psoas, other muscles, so you can test different muscles. You can roll over. You can test your glutes and a lot of these different muscles. So we often will see that when people have these issues that various muscles will be shut down or inhibited. And we use a handheld dynamometer because one of the interesting things that this traditional zero to five muscle testing scale was based on initially when there was a polio epidemic, and people were having paralysis or partial paralysis. And so most of the people that we're working with, zero through four are, you can't turn the muscle on at all, you can engage the muscle, but can't lift, you can lift the leg and hold it up, you can hold it up, but can't resist.

Garrett Salpeter (:

So most of the people that we're working with are between a four and a five, and going from a four to a five doesn't give a ton of insight there. So we actually will use a little force meter in our little handheld force meter to push down, and we'll say, "Okay, you can exert 30 pounds of force on one side and 50 pounds on the other side. Oh, my gosh, to go from 30 to 50, we need to get 2/3 stronger. That seems like it's going to take a heck of a long time." And then we'll go through our process. We'll find where the body is inhibiting and shutting down muscles, go through that resetting, recalibrating, re-educating treatment process. And sometimes in that same session, that leg that was 30 pounds will go up to 50 pounds. And you'll think, "Oh, my gosh. How did we get 66% stronger in 30 minutes of treatment?" Obviously, we didn't just build that much new muscle or anything like that. What we did was help that person tap into the muscle that they already had. They were just preventing themselves from displaying it, from activating that muscle.

Garrett Salpeter (:

So it's sort of like if there's a governor in your car. If you have a really fast car that can go 180 miles an hour, but you have a governor that limits it to 100, there's that 80 miles an hour untapped potential. We're trying to help people get into that and to tap into that potential to just be able to use what capabilities available to them already. And it has to do with breaking through those self imposed limitations that happen in response to injury and trauma. It's that neurological response to injury. So that one assessment is just looking at the ability to engage muscles, to turn muscles on, looking at basic strength in very simple positions, like holding the leg up there.

Garrett Salpeter (:

And then the other assessment that we do is that mapping around, scanning around with one of our electrodes on the body, sending this direct current signal to identify where there's hypersensitivity or discomfort, or those hyperactive areas, which are associated with the protective responses, where the neurological protection, where that governor is being imposed. Those areas will be more sensitive. And by working through it, we can help recalibrate that to down regulate or reduce that sensitivity, which is the same as saying, lifting off that governor that's being imposed neurologically.

Sanjiv Lakhia (:

Right. So the muscles that you scan, those are guarding, those are inhibiting the normal range of motion, normal strength of the kind of injured, affected area. So it sounds like what you're doing is you're using a technology. Now I'll say in traditional osteopathic medicine, because I'm a D.O., we would look at muscles in a similar manner and try and, quote, turn them off, so to speak, with techniques like strength, counter strength, functional positional release techniques, or even HVLA techniques. So that's why if someone comes in with an ankle issue, we're checking their hip, their knee, and their back. And it sounds like you're applying technology to it, and it's a good lead in to your device that you've named the Neubie. And I'll just kind of read a little passage from your book on page 31.

Sanjiv Lakhia (:

First, you talk about the differences between direct current and alternating current. And then you say that the Neubie can have a different effect both because its wave form is designed to match the rate at which electrical charges transfer across nerves and because it uses direct current, which is what the nervous system uses. So elaborate on that a little bit for the listener because I know people are listening right now. And there are many, quote, unquote, nerve or muscle stimulators on the market, each with its proprietary wave form that is supposed to give you a different therapeutic outcome. So explain to us a little bit about what you've invented and how you use it, and kind of what the results are that you're seeing with it.

Garrett Salpeter (:

The biggest difference is the use of direct current as opposed to alternating current. And in order to understand why that's meaningful, I think we have to start with a little bit of historical context. So direct current was being evaluated, was being used in the '60s and '70s, particularly in the Soviet sports science research program. And there were numerous benefits, but there was one major problem, which is that when you use direct current, you'd get charge accumulation, positive charges would build up around the negative electrode and vice versa. And because of this charge accumulation, you would end up getting stinging and burning of the skin. And the Soviets literally would leave burn marks on the skin of their athletes. And they could do that for mother Russia back then, when everything was in service of showing the world how great their system was.

Garrett Salpeter (:

But we obviously couldn't do that here. We're not going to burn people. Right? So direct current totally fell out of favor. And in its place came alternating current, and the devices that are in use everywhere are alternating current for that reason, because you're able to get alternating current into the body without any of that skin discomfort, because you don't get any of that charge accumulation. It just goes right in and stimulates muscles. And there are some benefits for sure. The issue and the reason why we are so excited about bringing direct current back is because when you have an alternating current signal, that signal goes back and forth, back and forth, back and forth, when you turn it up to a high enough level to really make a difference in retraining the neuromuscular system, when you turn it up to those levels, you end up creating this back and forth, back and forth, back and forth signal, and you cause muscles to co-contract and fight against each other. That means muscles on both sides of the joint.

Garrett Salpeter (:

So if we're going back to our car metaphor here, it would be like you're driving your car, hitting your throttle and brake pedal at the same time. And obviously, that's very inefficient and it can lead to extra wear and tear, and possibly even injury over time, where we're trying to make the body more pliable and supple, so it can absorb force and move through greater ranges of motion, whereas driving with the brakes on makes everything more stiff and tight and less able to bend. Right? We want to bend but not break. That's more likely to break when you're in that stiff, fighting against yourself type of status there, or type of state there.

Garrett Salpeter (:

And with direct current, what we're able to do is bypass a lot of that muscular contraction in order to speak more directly, more powerfully, more precisely to the nervous system. And that allows us to do two main things. One is this assessment process, scan around on the body. And by sending that, instead of just causing muscles to contract everywhere we go, we're sending that sensory signal, that input that tells the brain and nervous system that area is being used, is being loaded as if someone was actually lifting weights, or stretching, or using that area of the body, tells the brain and nervous system that's happening. And it's like it's presenting that information to the brain. And then the brain will say, if things are working well, it'll say, "There's nothing threatening about that. No big deal." And it'll just feel pleasant. It'll feel like a nice buzzing, no problem at all.

Garrett Salpeter (:

But if we stimulate an area where the brain is trying to limit output, or where there's a spasm being imposed because of this response to the, quote, unquote, throwing out one's back type of injury here, if we scan over any of those areas, the brain sees that and says, "Whoa, whoa, whoa, whoa, whoa. That's new, that's different, that's threatening," and then responds to perceived threat. The brain triggers an output of pain, and so it feels kind of like a trigger point. It's more sensitive and can be a little bit uncomfortable, but these spots tend to stand out very precisely. And so it allows us to identify exactly where these neurological issues are. And then by sending that direct current signal, instead of just again contracting the muscles in that area like traditional electrical stimulation, we're actually able to create more neurological input to change those nervous system patterns to recalibrate that response to injury and trauma, to help reactivate muscle function, to restore range of motion and mobility, reduce spasms, and lead to an overall acceleration and enhancement of recovery.

Sanjiv Lakhia (:

When you do a scan or treatment, are you literally afterwards able to palpate, for example, if someone has a palpable tender point in their glute medius, does that resolve with the treatments that you offer?

Garrett Salpeter (:

It often will improve within that session. Sometimes it'll with one session, you'll do it and it'll be gone for weeks or months. Sometimes it'll improve in that session and it might regress a little bit over the next few days. And that's of course why you'd want to do multiple treatments. But you often will see improvements in those types of spots, yes.

Sanjiv Lakhia (:

A question that occurs to me is, first of all, I really like the idea. It resonates with me that we don't just focus on the injured area, and that you look at the neurologic system, the central nervous system, the autonomic nervous system's impact on the injury the role it's playing with perpetuating the injury. So that to me makes a lot of sense. In your research and experience, where do you find to be the sweet spot? Because I would suspect that initially, those reactions, those muscle guarding reactions or episodes, are serving a purpose. And you don't want to necessarily turn that switch off too soon. But at the same time, if you let it go on too long, in and of itself becomes its own problem and perpetuates the injury. So what have you recommended to your clients about proper timing of going with an approach like this?

Garrett Salpeter (:

That's a fabulous question. Of course, safety first. Right? First, we want to do no harm to patients. And then of course, next is wanting to help them. So keep safety is definitely the number one priority. Before I get into that, I'll just close the loop on the previous question about direct current. So these benefits of direct current, there also is a benefit on tissue healing. When you have that direct current electric field, it can accelerate some of the body's process of tissue healing. And what we were able to do to get direct current in the body without burning the skin is to add this proprietary wave form feature that reduces the charge buildup that you normally get with direct current, so we can get those benefits while still having the comfort and the elimination of the risk of burning of alternating current. So it's kind of the best of both worlds there, the physiological benefits of direct current with the comfort of alternating. Sorry, I just wanted to close the loop there.

Sanjiv Lakhia (:

Thank you. Yeah, that's a good question. I have many physical therapists who are going to listen to this and probably ask me that question, so I appreciate it.

Garrett Salpeter (:

Yes, yes. Well, sorry I didn't finish the answer the first time around. But so to your point about safety here, it's a very good question. There's a few elements of this that I think we need to consider. One is, yes, these protective mechanisms are necessary. And we want to make sure that we don't eliminate them completely because then we're going to be vulnerable. The problem is that they're oftentimes set to conservatively. And one metaphor I like to use with patients to describe this is to say, "Imagine if you're in your office at home." And if you have children, this might make sense to you here. If you have a child who has a rubber snake, and they come, they throw it into your office. And if you jump up and react, and you scream and yell and you run out of the room, that could be a bit of an overreaction.

Garrett Salpeter (:

If a venomous snake, if a real cobra or python is actually slithering into your office and looks like it's about to attack you, that type of reaction has real protective value. Being able to have that adrenaline rush to run away, or figure out how to hit the snake, find an implement and fight it, or protect yourself somehow, that reaction has real protective value. But if you used that same reaction to react to a rubber snake as you do to a real truly life threatening snake, then you're overreacting and it's ultimately wasteful, or potentially counterproductive at least. And a lot of times, that's what the body does.

Garrett Salpeter (:

A lot of times, it overreacts, and a lot of that has to do with just bad habits. Use it or lose it is a very profound principle. If we don't use all these ranges of motion that are available to us, over time, the body starts to narrow what it allows, where it allows us to go. And it thinks that going outside of that range is unsafe. And so not only do the tissues shorten, but our brain narrows the range of what it perceives as safe. And if we don't explore those range of motion, that window of opportunity just gets narrower, and narrower, and narrower, and narrower. So a lot of times, these are set to conservatively. And the good news is that when we go through our treatment process, we're able to tell to a very significant degree, able to tell how much of this neurological reaction is appropriate, versus how much of it is overreacting to a rubber snake as if it's a real snake.

Garrett Salpeter (:

And what I mean by that is if we go through our assessment and treatment, and there truly is a significant structural issue, we'll see little to no change at all, whereas at the other extreme, if it's like the example of someone who has these really bad back spasms, but doesn't actually have a significant spinal impingement, or severe herniation, or a stenosis, or a severe structural issue, if we're working with a person like that, they may walk in at a nine out of 10 pain and leave at a zero, and [inaudible 00:26:28] reaction might all go away within one treatment. And of course, those are the extremes. Many people are somewhere in between, where they notice some improvement, some reduction in symptoms, but they still have some stiffness, some limited range of motion, some pain. And so those protective patterns haven't been eliminated completely. They've just been re-calibrated to an appropriate level for where they need to heal, for where they need to be right now in order to support healing.

Garrett Salpeter (:

And I've seen that we now having treated ourselves in Austin, 8000 to 10,000 patients, and having a couple thousand certified doctors and therapists who have treated many thousands of their own, we've seen that the body still is able to keep these protective mechanisms at the level it needs. And based on how much improvement we see, it allows us to get that insight of how much of this issue really is structural and just needs more time for those tissues to heal. How much of it is functional and is going to allow us to make these quick breakthroughs? And a lot of times, there's more functional component to it than we might first thing. I think we tend to be in our current model, more structurally biased.

Garrett Salpeter (:

And that seems like the big source of the breakthrough here, is that by prioritizing this functional approach, we're able to help more people make more progress faster. And yet, it's not always 100% right away because those protective mechanisms are still in place, and they do stick around. We don't just override them completely when we follow the process and we do things like we spell out in our certification and training programs.

Sanjiv Lakhia (:

Yeah. In our group, which we have one of the largest neurosurgery groups in the country, and we do have our own in house physical therapy, our model is both. We definitely look at treating the injury at hand, but then also the comprehensive rehabilitative approach, where you kind of work from both directions, and we get the best outcomes when we combine it. And I'm going to be interested to talk with some of my team about your method and kind of hear their feedback. Two things I want to touch on before I let you go, and thank you again for taking time to be on the show today. You put in your book, and my jaw dropped when I saw this, a screenshot of your Oura Ring, showing three hours of deep sleep. And my first thought was, "This is Photoshopped. There's no way."

Sanjiv Lakhia (:

For those who don't know, an Oura Ring is a fitness ... It's a sleep tracker. You wear it at night. It can give you measureables regarding the quality of your sleep, duration, REM sleep, deep sleep, et cetera. So it's very useful for just tracking how well you're sleeping. For me, a good night is 90, 90. If I get about 90 minutes of deep, 90 minutes of REM, and seven to eight hours total, that's good. I feel good. And I've probably experimented, my wife will laugh at the different things I've tried to improve my duration of deep sleep, to no avail, whether it's supplementation, blue light blockers, et cetera. So I need to know what happened there. And the Neubie device, is it the holy grail we're talking about? Or was that just a lucky night, and you got to put it in the book?

Garrett Salpeter (:

So first of all, it was a totally legitimate screenshot from my Oura Ring app. And I will say of course I did cherry pick probably my best night ever. I have had other nights. I've had a couple nights a month, I'll have three hours or so of deep sleep. And my goal that I write about in the book is to have at least half the night in those two most powerful, most restorative stages of sleep, deep sleep and REM sleep. And I think that makes our time in bed more efficient, and allows us to get more true restoration done in the same number of hours. So it's both quality and quantity of sleep. And I really want to emphasize quality. And the things that have moved the needle for me are, I've done that. I've done the same things you mentioned, blue light blocking, after dark, wearing the glasses, a lot of things I talk about in the book.

Garrett Salpeter (:

I'm big believer in meal timing and having at least three or four hours before bed of between my last meal and when I go to sleep. All that stuff helps. But what really has moved the needle for me in that regard is using the Neubie generally for my workouts because of the neurological effect. It's interesting. A lot of times we work out, but the neurological input, so there's cardiovascular components, there's muscular, there's all these different components to working out. Neurologically, a lot of times we may do something, but it's not actually stimulating enough. It's not creating enough input to the brain for the brain to trip the alarm, to get the message that hey, something really significant happened here. And now, yes, it is time to shift into full on recovery mode to recover from that, to restore, or to rebuild, to repair, so we can come back stronger next time.

Garrett Salpeter (:

So training in this neurological way, using some of the techniques, both with the Neubie and other exercises that I describe in the book has helped. And then what's really made the dramatic shift in those statistics in the heart rate variability during sleep, and deep and REM sleep, is this what we call our master reset protocol, doing this before bed. So we'll do it with patients after their workouts, or after their physical therapy sessions, where we'll lie down. It's basically our version of a vagus nerve stimulation. We'll have pads back of the neck, the base of the skull, brain stem area where the vagus nerve leaves the brain. And then we'll have the other pads down on the balls of the feet. So we get these very neurologically rich areas locally at the feet and at the base of the skull. And then we get literally everything in between, the currents going through their whole spinal cord, really going through the whole body. So it has this both local and global effect.

Garrett Salpeter (:

And we see before and after, immediately before and after, significant changes in heart rate variability. So we know we're having a really meaningful effect on the vagus nerve, creating a parasympathetic shift globally. And I'm fortunate enough to have one of these devices at home, so I do it right before bed. And some of my experiments on myself where I've done it right before bed every night for a month, and some of my sleep numbers got just crazy in terms of deep sleep, REM sleep. And my HRV, my heart rate variability would be an average of 60 or 70 milliseconds overnight. And I'd have night where I'm doing these experiments where it'd get up to 150, 160, 170, and I mean, just numbers that I didn't even dream were possible until I saw them and tried this. So that's been one of the exciting things.

Garrett Salpeter (:

And we've done a study with another company called Biostrap, which the Oura Ring is a ring, Biostrap is a similar, very well validated tool that uses a wrist strap. And we've done some studies to look at the effects. And we've seen that patients generally going through these treatments also are seeing improvements in heart rate variability, deep sleep, better blood flow, as measured by arterial compliance or arterial elasticity, and reduction in resting heart rate without doing any cardiovascular training. So we're seeing some cool autonomic effects there. Maybe that was a little bit longer answer, sorry. But I love these.

Sanjiv Lakhia (:

No, that's good.

Garrett Salpeter (:

I get excited about this one.

Sanjiv Lakhia (:

Yeah. It's a real differentiator. I mean, I think that is very fascinating. I hope you continue to put out some research on the effects of that. In fact, maybe you'd love to talk, see if we can get our hands on a unit, some training, and try it on some of our patients in our therapy center here and report back to you. But one of the things I like about the book is that it's not just ... Some of the books that I see, it's kind of like selling something. But I think you talk about a really comprehensive approach in addition to the treatment protocol. You're talking about the importance of sleep, the importance of good nutrition and hydration, and maybe some fasting and things like that. And I'm kind of the integrative health doc in our group, and actually currently finishing up an integrative health fellowship at The University of Arizona, so it resonates with me tremendously. And I can't imagine that this isn't also helping the people you see recover much faster. Thanks for sharing that.

Sanjiv Lakhia (:

And before I let you go, I always like to have the people I interview share a nugget or two about maybe their morning routine, or a great influential book they've read, or a podcast, just something that fills their cup that people listening to this episode today might want to look into and get some value from.

Garrett Salpeter (:

Yeah. First of all, I love that you're doing that program at Arizona, and just want to acknowledge you for bringing that to your patients. I mean, I think that differentiates you as a physiatrist and will really help you give better care and bring a really valuable perspective to your patients.

Sanjiv Lakhia (:

Thank you.

Garrett Salpeter (:

So that's awesome. In terms of my own routine or personal nuggets, one of the things that also helps my sleep is actually on the front end of the day. I know I talked about things before bed. But on the front end of the day, one of my favorite morning ritual is to get up and drink a big glass of water, and stand next to my red light panel. I've got a big red light panel, if you could see behind me on the wall in my home office. And I turn it on in the morning, so usually between 5:00 and 6:00 AM. And that does a couple things. The red infrared light does a lot in terms of increasing blood flow, reducing inflammation, helping mitochondrial function, energy, energy generation. But it also tells my brain, hey, it's morning. It's time to wake up. And it helps anchor my circadian rhythms. So I like to stand there, and I like to use that time to do some strategic reading, or do things that I don't normally get to do in the middle of the day when things are happening, when there's meetings and things like that.

Garrett Salpeter (:

So that's been a real big one for me, is doing that red light panel in the morning, where my brain sees the red light and says, "Oh, it's sunrise. Oh, there's more red and infrared light. It's morning time." And it really kind of anchors that circadian rhythm. I love that. And then books wise, in terms of this health space, there's several people that I like. I like Dave Asprey. I like Ben Greenfield. I'd probably recommend two books by Dave Asprey. I like Head Strong and Super Human. I like both of those books a lot. And I like his books.

Sanjiv Lakhia (:

Yes, thanks for sharing that. Again, those guys are really good and they're promoting a lot of health awareness across the world. And I appreciate that you take the time to take care of yourself. I'm a big proponent of clinicians having their own kind of self nurturing routine, so we can show up as our best selves. So I want to thank you for being on the show today. It was really enjoyable learning about the good work you're doing, Garrett.

Garrett Salpeter (:

Thank you so much. It's been a pleasure being here. And you're doing great work yourself, so it's really, really cool to connect.

Sanjiv Lakhia (:

All right. We'll talk soon. Take care.

Garrett Salpeter (:

Bye-bye.

Outro (:

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.

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