Dr. DJ Kennedy

The numbers are 80 to 90% of people have low back pain at some point in their life, which tells me 10 to 20% of people have a bad memory.

Brittany Thomas (co-host)

This episode is a real pain in the back. Our featured guest is Dr. DJ Kennedy, chair of the Department of Physical Medicine and Rehabilitation at Vanderbilt University Medical Center. His research and clinical practice focuses on the aches coming from one of the most complex structures of our body.

Dr. DJ Kennedy

For the spine, we have L4-L5, L5-S1, we have recurrent problems, we have discs, we have facets, we have all kinds of things that can cause problems. 

Brittany Thomas (co-host)

Our show host and someone who’s experienced back pain himself, Rob Pease,  he interviewed  Dr. Kennedy about spinal problems, and some of the things he’s found helpful- including The Gokhale Method, which we featured in our season 2 episode called “Primal Posture for Modern Pain”.

LIFE AS A WEIGHTLIFTING EVENT 

Dr. DJ Kennedy

People that have reflux take reflux medicine. People that have high blood pressure take high blood pressure medicine. The medicine for your back, for most people, is doing some form of exercise. And I think that having the right posture throughout that is actually one of the things that can augment the process.

Brittany Thomas (co-host)

This is My Body Odyssey, a show about the rewards and challenges of active lifestyle. I’m Brittany Thomas. Is there any greater challenge to living actively than severe, recurrent back pain? More from Dr. Kennedy in this episode on why spinal issues are so persistent, starting with his own unique path to physical and rehabilitation medicine.

Dr. DJ Kennedy

My background before I went into medicine was both a competition weightlifter as well as a strength and conditioning coach at Florida State University, before I went to med school. I love the human body. I love exercise physiology, making people better. And started med school with no idea what I was going to go into, stumbled across the great field of physical medicine and rehabilitation, and really got to watch people get better, help guide them through recovery, and realizing spine was one of the most disabling conditions in America, and one of the biggest causes of disability, decided to focus my practice on care for the spine.

NO SHORTAGE OF BACK PAIN

Robert Pease (co-host)

Yes, no shortage of patients I would imagine. A physiatrist once told me, we know how to fix hips. We don’t know how to fix backs. Is there some merit to that observation?

Dr. DJ Kennedy

What I would say is back pain and back problems, including the neck, are different than hips, in that there’s a lot going on there; a lot of people get back pain, but they’re not all getting the exact same thing. Not to say we’ve solved hips completely. But there’s a lot less people walking around on disability because of their hip than because of their spine.

Brittany Thomas (co-host)

The back is far more complex than the hips or any other joint. Because it’s a system of joints, with layers of attached muscle and networks of nerves emanating through these narrow spaces to every other region of the body.

Dr. DJ Kennedy

And the analogy I give is, you know, our discs are kind of like wheels on a car. And you can abruptly blow out a tire,  that happens, that’s an acute disc herniation.. You can gently let the air out over time and get a flat tire. That’s kind of a disc bulge. And what predisposes to that? There’s a lot of things. What kind of car are you driving? How are you driving? What accidents do you have? But also, are the wheels aligned appropriately? So, you know, to me, while you can’t always change your genetics or what you’re driving or your predisposition to something, you can change some of these other environmental factors that may be contributing to it. 

DEPENDS ON THE CAR

Brittany Thomas (co-host)

Depending on your car, your make, your model, and how you drive it, the recommendations for what to do about back pain are going to be different. But, Dr. Kennedy does make some general recommendations for everyone- informed partly by his former life as a competitive weightlifter. 

Dr. DJ Kennedy

Anyone that’s carried groceries from their car to their house, anyone that’s moved a chair, anyone that has done anything, has moved heavy things. And heavy is relative, but life is that weightlifting event. So having your spine have strong muscles around it to protect it throughout life is an important thing. And I think we do have to focus on that with the core stabilization exercises. So the basic theory is, have good range of motion in your legs so you can keep your back straight and have a strong spine, so that you’re not having to lift with an abnormal posture and you can lift in the correct way. And by lifting, sometimes I’m meaning even bending over to pick up a newspaper. 

BACK SPECIALIST WITH BACK PAIN

Robert Pease (co-host)

Yeah. Now, have you had any back issues yourself?

Dr. DJ Kennedy

Oh, yeah. Again, that 80 to 90%, I’m there. I manage mine through a variety of posture, exercise, et cetera, all kinds of ways I can manage it. But I definitely have both low back and neck pain. Maybe that doesn’t make you feel overly ambitious towards your doctor to say I’ve solved it all, but I am managing it. I am working, I am able to do stuff. I’m able to engage in life despite having back pain.

Brittany Thomas (co-host)

Back pain is so common, even spine experts are not immune. Maybe that’s what motivates Dr. Kennedy to be open to any treatment that will help his patients- such as Esther Gokhale’s primal posture approach. Which Dr. Kennedy learned about in a former teaching position.    

Dr. DJ Kennedy

I was faculty at Stanford, which is close to where she practices. And, um, started sharing patients and sending patients to her and hearing patients that said they were doing well with some of her treatments or had tried her treatments. And I am always looking for whatever can work for my patients. I realize there’s not one magic cure for back pain. If there was, we would not have back problems. And anything I can do that is movement based and getting people to feel better without giving them lots of pills, surgeries, or even injections, I’m all for.

HOW CAN POSTURE HELP?

Robert Pease (co-host)

So tell us, if you can, when would you recommend someone to go to Gokhale Method versus, for example, to physical therapy?

Dr. DJ Kennedy

Yeah, so as a physical medicine and a rehabilitation doctor, I do think anytime you have an abrupt change, a change in neurologic status, “I’m trying to pee and I can’t”, “Oh my gosh, I’ve lost ability to climb stairs” or anything. You need to see somebody in an urgent fashion. Whether that’s a walk-in clinic, or some level, that abrupt change requires a doctor. 

Brittany Thomas (co-host)

Dr. Kennedy says that when the issue is more of a slow, wear and tear issue, movement-based solutions like physical therapy and the Gokhale Method can be very effective. And even prevent the problems before they start.

Dr. DJ Kennedy

I definitely see people that are hunched over, you know, we’ve, we’ve evolved to stand up straight and we’re de-evolving down into this kyphotic, bent-forward posture because we’re all on computers all day long. And I do think getting people in the correct position, with their monitors up, with their keyboards parallel to the ground, with their elbows, with their arms parallel to the ground on the keyboard, will help prevent some of these repetitive, strain-type injuries.

FEELING BETTER

Robert Pease (co-host)

Can you, in just a few weeks, with fairly simple changes, can you begin to feel improvement? Have you seen that in your patients and does it seem realistic?

Dr. DJ Kennedy

100%. What I would say from all of my therapy based techniques, the data is very consistent, in that people that get better, get better fairly quickly. So physical therapy, six to eight visits, meaning you shouldn’t need thirty visits. The Gokhale Method same thing. If you’re not noticing in a few weeks, for the vast majority of people, if you do not notice improvement in a few weeks time frame, the given technique, in isolation, is probably not what is needed. I think there’s a large number of treatments, that clearly nothing works for everybody, but most of them work for some level.

Dr. DJ Kennedy

And the trick is to really be evaluated to try something, and then really thinking through a least-invasive to a more-invasive paradigm, is how I thin. When we think we have therapies, which I would include the Gokhale Method in, we have medicines, we have injections, we have surgeries. There’s a time and place for all of those things, right. There really are. And it depends upon what’s going on, what’s been tried, how severe, what symptoms are happening, a number of factors as to what is ideal for an individual patient.

Brittany Thomas (co-host)

A cautionary note here if you’ve ever been stuck in bed with back pain: there’s no single therapy that will work for all, or even most, of our back issues. And that’s just due to the complexity of our anatomy and variety of stress and strain that we take on through exercise, for sure, but also our daily habits.

THE OVERALL PICTURE

Dr. DJ Kennedy

I have a three year old, so I could sing a song about the hip bone being connected to the backbone. We know that the body has a bio-kinematic chain. We know that. We know that it starts with the foot. If you’re over pronating on the foot, your foot is going down and flat, that will throw your knee immediately, abducting the knee. Has effects on the hip and has effects on the back. And I think that to really understand what’s going on with a patient and the cause of their symptoms, you do have to take a look at that overall picture. It’s one of the reasons I do like posture and strengthening and all of those aspects that work on the entire spine and movement patterns to get people in the right flow and the right way of working, so they are sitting, lifting, standing appropriately.

Brittany Thomas (co-host)

Dr. D.J. Kennedy of Vanderbilt University. A respected expert on spinal injuries and therapies, including the Gokhale Method. And, hey, if you have a friend or colleague with back issues, please share this episode with them. And any suggestions or comments are welcome through our social media or our website, or e-mail us at info@mybodyodyssey.com. Next up on My Body Odyssey: stories from one of the most-storied races in the running world, the Falmouth Road Race. Which started out as a pub crawl in 1973. We met up in Falmouth this year with the only runner to have completed the 7 coastal miles of this race all 51 times, Dr. Brian Salzberg of the University of Pennsylvania. 

FALMOUTH LEGEND

Dr. Brian Salzberg

I came up to Falmouth and I knew the podiatrist, one of the podiatrists in town, who had been a runner, quite a good runner. And he said, “Well, I know how much it means to you”. So he taped up my foot and gave me a pair of crutches. And I did the seven mile course on crutches in 2008. And as far as I know, I still have the crutch record for the course.

Brittany Thomas (co-host)

A running odyssey like no other, next episode. And a race like no other, the 7-mile Falmouth Road Race. I’m Brittany Thomas. My Body Odyssey is a Fluent Knowledge production. Original music by Ryan Adair Rooney.