what are things people are doing that may be causing them to be more likely to have back problems and then what sort of things do you recommend as prevention when you're young and healthy to avoid those things you said something really important best to start as soon as possible sort of like if you want to keep a car forever you want to start taking care of it from day one so the time to start is today and I know it's hard because I've not started either even though I have great plans too but the most important thing thing is to be really healthy and fit because one g of gravity on planet Earth is a lot more than you think there's a reason why we use the term dead weight you try to pick up 150 lbs like a sack of rice you'll be surprised how heavy it is but I weigh about 150 every time I stand up I'm just throwing around that weight and the discs the Facet Joint cartilage are just like the treads on your tire they're going to wear out the question is how fast and what can be done to mitigate it and my guesses is that the most important thing you can do is to be really healthy and fit so that all the muscles that surround your spine are not only like strong but more importantly coordinated so that as you just literally just bend over to get something an incredible amount of pressure goes through your discs from all the weight that you're putting on it and if the muscles are working in a way that redistributes all those loads across all the five discs it'll probably last long longer than somebody that is really uncoordinated and it's going to basically find the weak disc and then just keep going down that road yeah so when you bend over to pick something up like keep your back straight and use your lower extremities sort of stuff and use the muscles in a in a way that um redistributes the loads to do that and the way to do that is the exercise that those muscles are used to it so what are some good exercises that people can do particularly uh to strengthen the muscles around the spine everyone focuses on just strengthening the core and it's mostly the abdominals but I found that that's not that helpful what's more helpful is to help them find an activity that they enjoy doing because this is like watering a plant you have to water it on a regular basis you can't forget about it for 3 months and then expect it to do well so that's that's what I really focus on a customized exercise program and you can tell how much work that requires that requires a really good physical therapist to get inside the person's head find out what they like and don't like and then leverage that information to find an exercise program they can do on their own for like until they to heaven so if someone doesn't if someone doesn't have access to a physical therapist or like Specialized Care how can they sort of design their own program like what sort of exercises should they look for in terms of is it just core strengthening and core meaning the whole core not just abdominal is it back chest and back like what sort of thing should they focus and what areas of the body I'll tell you what I do for most of my stuff and and when I want to do something I hardly ever like go to classes or hire coaches I just open up my phone I start looking through social media and I find a lot of guides on um all the different exercises there's so many out there I don't have any that are just popping to my mind but there's a lot of really good exercise physiologist that can help you develop a program but you know what I noticed for most of us what you need is you need like a little I don't know a buddy somebody that you're kind of it's like a consequence buddy I can't remember what that's called but accountability buddy accountability buddy yeah you need somebody that you need to find somebody that is kind of wanting to start getting fit and going down the same Journey as you and it can't be your spouse either it has to be somebody that if you kind of like let them down you're going to feel bad about it that's true cuz they will get you there but I will say that my husband and I go to the gym together and lift weights together and it's actually fun for us to do together as a couple you lucky yeah um so sometimes you can incorporate your spouse but yes I can definitely say no I don't want to today and make him go alone and I won't feel bad about it see that's what I'm saying he's got to leave the house and make you feel so guilty you're just going to say I'm coming forget it yeah exactly cuz once you get there it's amazing you'll get a good workout you just got to walk in the door that's the hardest thing what about injuring yourself working out because we see that right especially people who do a lot of body u a lot of weightlifting or even a large amount of endurance exercising they can injure themselves so how can you protect yourself when you're doing this the thing that you should do to help your spine Health overall that's one of those questions that I have no answer for because you're just going to get injured intermittently probably the best thing to do is to have either a coach or or a partner that can objectively see what you're doing and if you're overdoing it kind of hold you back because it's really hard to self-regulate since I'm not very good at that I keep a journal so just keeping track of the activities that you do because sometimes you may overdo something and not realize it for 2 or 3 days and and think like I don't even why this is happening because a lot of my patients will start a really good exercise program or good PT program they'll have a flare up and they'll conclude that PT is bad for you and just completely stop MH instead of trying to identify what part of that PT was probably not right for them backing up and regrouping and keeping on with the with this journey of finding this kind of perfect program for yourself because it has to be customized I noticed there's no single program that works for everybody and backing up in terms of like listing to your body pains and saying okay I should stop for a few days a week till the pain goes away like how do you or or going back on the amount of time or the weight amount that you're lifting if you're lifting weights yep oh by the way I tell my patients all the time if the little voice inside your head says something about this is not right I want them to listen to it and I even want them to tell their therapists and their coaches like I don't know what it is about this but something doesn't feel right about it Dr Kim told me to tell you say that so I don't know why but that's pretty important so I would listen to that but um in terms of trying to avoid injuries you almost have to get injured every once in a while to figure out what injures you because I'm a big believer and trying to constantly get better cuz one of the other weird things is that the body gets used to a certain exercise so if you do the same exercise all the time after a while it's not that helpful anymore you want like I do 50 push-ups every night I don't think it's helping me anymore I need to do something different because I probably my body somehow gotten used to it or change the way you're doing push-ups or something yeah and it's like really efficient now so it doesn't really help me yeah that's a good good advice I will just share a story so I developed a laboral tear in my hip and I um and it was quite painful for some time but I was still able to ambulate and do my normal activities but I did you know slowly I I backed off on the the exercises that would really strain that joint and then as the pain got better started to do them at lower weights and now the pain is almost completely gone uh it rarely flares up um because I think I've strengthened the muscles around the joint there and so I think that's good a good advice in terms of like yeah take it take it easy like okay it's okay if you have to stop a certain exercise like it's not the end of the world you can do other things to continue to strengthen uh and slowly build back up yep I mean if if I had to just recommend one like kind of parameter is to back up 50% of what you were doing mhm uh until and then just go up 10% per week mhm and you keep track for some people it'll just be 10% per week some people will be like I want to do 20% next week and some people it has to be 10 20 and then five so uh unfortunately it's so different everyone that I all my patients just want like give me a number it's like well I can give you a number but it's probably not going to be accurate if you keep track that number will be your number and that's the number that we yeah want to go after by the way I'm a big believer in the future of healthcare has to be customized absolutely including our blood tests and things like that yeah I think um it's interesting we had Andy Galpin on the podcast and he's like you know when you look at our normal values they standard deviation of two you know two or whatever so you can be from 10% to 90% and be in the normal range but that may not be optimal for you and I think it's really important to sort of assess what works for you will not work for everybody else and trusting your own body as a guide is really valuable I think when we have like kind of continuous monitoring that'll be make it that'll make it a lot easier because then you can use your own history and if you can then enter information like I had a really good day today I felt really run down and you just start Gathering up all that data just on yourself just through history I bet you you're going to have information that is much more pertinent to you you don't have to wait until you're really sick I think it's good I think sometimes it leads to unnecessary anxiety continuous monitoring like you might see a blip in something right and you're like oh my God my like this went off today and now my whole like oh what does that mean and spending a lot of energy and anxiety on that one thing I think generally looking at how you overall feel knowing there's going to be aberration day to day your hormones change day to day your whole body changes day to day depending on the stress you're exposed to and the and and the sunlight you're exposed to and the like everything right like how well you sleep the night before so I think um there's so many factors and to figure out what exactly you know minutia you need to change is going to be very difficult and probably at the end of it sleeping well getting good exercise um staying hydrated like the basic things will always remain true to improve your health so in terms of you know acute pain acute back pain is very very common like you get injured something happen but the good news is at least to my knowledge is that very small percentage of people with acute back pain go on to have chronic back pain and I think we've talked on you know what can you do in the short term in terms of pulling it back but are there other things you can do uh diet wise supplement wise when you're in the situation of having an acute episode of pain the number one thing is being really healthy and fit where the muscles that surround your spine acts like the world's greatest back brace so they're both strong and coordinated and then the rest has to do with being really healthy in general and if there's one thing it has to do with the inflammat system I would say that most Americans including me were all in a heightened state of inflammation relative to the way we probably were 20,000 years ago and it's because of our lifestyle we don't exercise enough we don't sleep properly we eat really highly inflammatory food we don't fast enough and then I think 20,000 years ago we're we basically evolved to like go from periods of Terror and then sheer relief we didn't have this kind of low NeverEnding kind of I have to work on my thesis or build up my career that is just constant without these because the the great thing about today is that we don't ever get terrified that the saber 2 tiger is going to jump out and eat us but we need that I think the people that are like these extreme athletes they they have to live like that because they kind of are in that that end of the spectrum but I think all of us are normally designed to have terror relief care relief not this low level of stress so this low level of stress sleep deprivation and a highly inflammatory diet in the setting of of lack of exercise a lot of the disorders that we have I think the chronic ones are inflammatory and my thinking is is that patients that have an annular tear um that are symptomatic are simply those patients that have that episode of back pain for like two weeks they have an anular tear but that anular tear kind of heals and when you get an MRI a year later it still looks like an annular tear but it's asymptomatic but the group of patients that remain symptomatic with chronic low back pain the inflammatory system has never turned off it's just chronically on and if you're wondering I wonder if that happens in other areas of the body if You' ever had tennis elbow golfer elbow plantar fasciitis shin splints IT band syndrome Rotator C tendinitis those are all chronic inflammatory conditions where the the inflammatory state is just stuck on the on position and they are painful I've had most of them and they last forever and if you image them you can hardly tell something's wrong and the surgeries to treat them are really just to go in there and muck things up and essentially start a new healing reaction so that hopefully this time around it'll go down the correct path but this whole inflammatory system I think contributes to higher incidents of chronic low back pain chronic neck pain and joint pain and variety of other things so how do we outside of sleeping well getting good exercise eating right what else can we do to reduce our inflammation I think you said all there's five things so there's exercise um good sleep good nutrition Stress Management and what is the fifth thing that's a lot though yeah so that so that this is why it's so hard I mean those are really difficult problems to to to tackle yeah what about we hear a lot about yoga and back pain how does yoga specifically as an exercise benefit people with back pain or prevention of back pain for that matter yoga is awesome because it's an exercise where you don't put yourself at risk for injury that much compared to like kickboxing which is what I like there's stretching involved and there's meditation involved the problem is like I couldn't do yoga myself I would I could like you could I couldn't do it it seems too boring or too awkward or doesn't fit my image I don't know what it is but like like my wife does this hot yoga my PA does this hot yoga I have zero interest in it yeah so part of it is is um the best exercise is the exercise that you actually enjoy doing and then you take that activity and you kind of like make it kind of safe and then add into it cross training activities so that you can get better and better and better without injuring yourself yeah that's the that's the most common message that I try to get across to my patients that's good you mentioned fasting how do you think fasting helps I'm not sure but my wife is a vegan and she has like Tim restricted eating and she's really healthy and I've been making fun of her for like 30 40 years but the last 5 years she's doing the mic drop all the time because now it's paying dividends in terms of like no aches no pains that sort of stuff yes healthy skin never gets a cavity never catches a cold so you think that there's some benefit in terms of reducing inflammation for fasting oh yes so fasting and a lwi inflammatory diet I think is if I had to guess the second most important thing to do exercise Follow by our diet and what would you avoid for a low inflammatory diet the most inflammatory things are melon proteins so my favorite a big fat juicy [Laughter] steak it is terrible for you yeah but I can't help it or or or good burger so cheese these are all my favorite foods red meat I'm not a big dairy product person but a lot of people love Dairy those are all the worst things you can eat despite what everybody says but it's true I know a lot of the car the carnivore diet people are going to come after us but you know there there's a lot of data there