Seth Grossman, MD, a fellowship-trained orthopedic spine surgeon, discusses his most common consults; how to differentiate emergent spine injuries from less emergent issues, and why both patients and practitioners alike should be doing yoga, Pilates, and trying to fly like Superman.

TRANSCRIPT

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Unknown Speaker  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians where Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have learned while we were memorizing the Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers. This podcast is intended for medical professionals. The information is to be used in the context of your own clinical judgment. And those on this podcast accept no liability for the outcomes of medical decisions based on this information, as the radiologist like to say clinical correlation is required. This is not medical advice. And even though the magic of podcasting may make it seem like we’re speaking directly in your ears, this does not constitute a physician patient relationship. If you have a medical problems, seek medical attention.
Unknown Speaker  0:57
On today’s episode, we speak to orthopedic spine surgeon, Dr. Seth Grossman about neck and back injuries, when to worry when not to worry, and why we should all be doing yoga polities. And once a day, get on our bellies and try to fly like Superman.
Unknown Speaker  1:13
Welcome back to the physicians guide to doctoring. On today’s episode, we have Dr. Seth Grossman, a spine surgeon in New York and New Jersey. Seth, thanks a lot for speaking with us today and helping to as you put it, demystify the spy.
Unknown Speaker  1:28
Sure. Thank you so much for having me.
Unknown Speaker  1:31
Could you just give us a little background on your training?
Unknown Speaker  1:34
Sure. So I went to medical school down in Philadelphia at Jefferson Medical College, which is now Sidney Kimmel, Medical College. After that, actually, before that I did I did some some graduate work in, in Computer Engineering, then maybe a little change in my career. So I went to medical school down at Jefferson and then I did my training at Albert Einstein Medical College monitor Medical Center. in the Bronx, and then I did a fellowship training in spine surgery at university California in San Diego. And since then I’m and again, I’m in private practice now I’m in a group. We have offices in Bergen County in North Jersey and then also in the city. few a few locations in the city. New York City, New York City. Yeah.
Unknown Speaker  2:20
This This podcast is international. So Oh, okay. Our audiences is broad. So, so Seth, you are going to talk to us about demystifying the spine. And so what are some of the things that you think all doctors, whether they treat related conditions, whether they’re referring physicians, like primary care physicians or er doctors, or treat things that are completely unrelated? What should all doctors know about the spine and I’ll give you an example. Let’s say you’re because in New York, New Jersey here we can get a lot of snow, your neighbor your neighbor is shoveling his driveway or her driveway and throws out his back, you know, whatever that means to me and otolaryngologist probably means something very different to you. And he he says, Hey, Doc, Hey Doc, because you know, everybody calls us Doc, if they can’t remember her name. Hey, Doc, just I just hurt my back. What do I do? So what do I asked him to make sure that it’s not a medical emergency? And should it not be? What do I tell him?
Unknown Speaker  3:28
Right? So it’s good question. So back pain in general is extremely common. It’s one of the most common reasons for loss of work in the United States. It’s one of the most common disabilities people have to miss work. And pretty much everybody at one point or another is going to figure out their their neck or their back. So something I see a lot in my office, something about, you know, a year, you know, people, my neighbors and such. So, it’s a very common occurrence and most of the time, vast majority of the time, you know, patients are going to be fine. The time is reassurance to your back you got arrested, you know, ice, you know, basically just kind of take it easy for a few days, maybe taking some incentives and that’s, you know 90% of the time patients will get better and within a period of time so red flags that you want to always you know look for is any kind of weakness or numbness So, just in general, the spine as an orthopedist, really any any specialties is a joint you know the series of joints in your back just like you know, your neck, your back just like just like a New York shoulder. So you can pull it you can strain it there are muscles and ligaments and tendons that can get injured and they heal much like any other joints. You know, the rest ice wrapping it that kind of thing babying it. The added complexity in terms of the spine is out there there are major nerves that run through that joint. So if something were to dislodge or press on a nerve, you know that can be dangerous and that you can damage that nerve and nerves. You know depending on how badly that they’re damaged or how much pressure is on the nerve not may not necessarily heal so you can end up God forbid with with neurologic dysfunction which can be permanent so that’s where I think everyone you know people get a little bit concerned a little bit over cautious with the spine so anyone who’s complaining of a neurologic type of a symptom that in my mind and you know in any doctor spine should be a red flag so doc I pulled out my back it’s killing me it’s throbbing my pain is 10 of the 10 I can barely walk that’s not uncommon complaint and that I see every day in my office and again I would say up in you know, 90% of those patients are are fine within a week. But you know, Doc, I pulled out my back shoveling my snow shoveling snow and now like, you know, my my foot is dragging and I can’t feel my toes, you know, is another sort of another added layer to that and that that may be something that is a little bit more serious.
Unknown Speaker  5:57
Okay, so numbness tingling, we can Does that warrant an immediate ER visit? Or should they follow up with you in the in the office?
Unknown Speaker  6:08
Yeah, it’s a good question. Certainly someone that should be seen soon. Whether or not it’s an emergency, I guess would depend on that the met you know, how bad the the neurologic dysfunction is?
Unknown Speaker  6:21
Nothing but loss of function probably is the is it? Would you say that that’s like a hard red line?
Unknown Speaker  6:27
Yeah, I mean, you know, you can lift your toes, that’s really an emergency, you have a little bit of tingling in your toes, that, you know, may not necessarily be something that has to be, you know, evaluated in the emergency room, especially during a snowstorm.
Unknown Speaker  6:42
So sounds like the differences sensory versus motor function. If it’s a motor function, it’s an emergency. If it’s sensory, then you can you know, wait for an office visit.
Unknown Speaker  6:54
Yeah, I would, I would say generally, obviously, that’s that’s a generalization but but clearly defined On the degree if it’s a little bit of numbness, a little bit of tingling, if you can’t feel your, any of your toes or you know something, but clearly, again, as the radiologist like to say, clinical correlation is required correlation Exactly. And then again, I’m sure everyone has heard the term called Aquinas syndrome which is which is a very rare but obviously, saddle anesthesia you know, bowel and bladder incontinence, anything like that, that happens soon after. an injury is also that’s that’s an immediate no trip to the emergency room. I will sort of preface that in that you know, patient versus back also has a little bit of prosthetic you know, prostate issues and has urinary retention that’s been ongoing for you know, 10 years and he takes medication for it doesn’t isn’t necessarily a quote Aquinas syndrome, and I think that we were very quick to, to jump to that. So loss of bowel and bladder basically where you can’t can’t feel or control your, your bowel and bladder movements. That’s an emergency and Having chronic issues constipation, you know, urinary retention is not there’s not a court appointed.
Unknown Speaker  8:07
If these things far preceded the injury then they’re probably unrelated to the injury.
Unknown Speaker  8:12
They’re probably unrelated. It’s probably not an emergency
Unknown Speaker  8:15
emergency or any of his his related. It’s not the fact that long history speaks to the lack of urgency. Okay, so let’s actually get back let’s get away from the urgent ones because those are the ones that that are going to be managed by you. What about the ones that aren’t urgent? So you you said Well, a few days of rest baby it for a little some end Said’s? What are you? Are you more specific than that? With your patients? You know, do you do you tell them more specific instructions? Three days, five days a week, wait until it feels better? Or is the data not just out there? And so, you know, I sometimes have trouble with this in my practice, like some people are sometimes looking For a specific answer, like a week, right? If I don’t feel better for my sinus infection in a week is it is it’s you know, doesn’t mean that the antibiotics aren’t working or three days, like they’re looking for something hard and fast. And the fact of the matter is, if you’re going to be giving someone a hard and fast number, you’re going to be kind of making it up, or are their recommendations.
Unknown Speaker  9:22
Right? By there’s a very good question. So I mean, there are recommendations in terms of the radiological societies are the biggest sites have ever released guidelines in terms of when you should say order an MRI, get, you know, get x rays, you know, do advanced testing and, and to be honest with you in today’s day and age, especially where we are in the New York, New Jersey area, I feel like patients, you know, pretty much demanding an MRI, you know, minute one when they when they walk into your office. So, you know, in terms of managing it again, even if it is, you know, I tell patients that You know, you pulled you back out, it’s probably a muscle sprain. But even if it is a herniated disc, which can be more serious, even that is going to get better with time and not necessarily need any kind of intervention. So, I generally try to, you know, I give patients either a course of events, heads or even, or even steroids for a week, and I haven’t time to come back and you know, rest, you know, if they’re, if they’re working, I give them a work note, especially if they do some manual labor. And I say within a week, if they’re not much better than we can go ahead and start ordering up tests and doing interventions, that kind of thing. So, roughly, you know, I basically say a week I don’t know that that’s an evidence based recommendation, but you got to give it a few days, everybody’s a little different. But typically, you know, most of the spasms and sprains will at least be 50% better, if not more in a week.
Unknown Speaker  10:50
And so does it improve outcomes to rest? It’s hurting or should they actually start to push their like will they recover from faster if they actually put limits like where’s where what I’m asking is where is that inflection point? Not necessarily time wise but time or symptomatic Lee or, like, you know, they shouldn’t lay on the couch until it feels 100% better. Right? So right.
Unknown Speaker  11:18
Where do you believe that and what point right sure so i mean i think if we extrapolate this out to a year right I think all patients are going to pretty much be better at that point whether they rested for two weeks or four weeks or I personally I definitely push you know, physical stretches. Walking you know, physical therapy definitely I think has a certainly in the short term definitely has a great effect that can really can really help but in the really immediate, you know, Doc, I just do my back out shoveling snow year is a time where I tell patients really just just rest. You don’t need to be lying in bed 24 hours a day to the point where you’re going to get a blood clot or something. like that but you know really just stay off your feet try to read you know I said minimize your your any kind of bending lifting and twisting for at least a few days and again after that then you can you know, you start to go do some stretches or see a therapist have a massage or something along those lines to try to get the muscle get the get the blood flowing to the muscles a little bit try to move a little bit for you know, stiffness and such.
Unknown Speaker  12:25
And is it is it any different for a neck injury or you’re saying this is not just lower back this is the entire spine? Yeah, I would say I would say you know, my advice is pretty much the same for the entire spine.
Unknown Speaker  12:41
You know, the neck
Unknown Speaker  12:43
can be a little more acute, you know, the spinal cord to get technical, you know, runs down your, your cervical thoracic spine, it ends around the top of your lumbar spine. So, most of the time you have a discrimination even a pinched nerve or ridiculous but the it’s a nerve root which is a little bit more tolerant of pressure and perturbation and then then the spinal cord itself. So if you have an injury where this you have pressure on the spinal cord that that also can, that can be a little bit more acute but in general, you know, just shoveling snow or sleeping wrong or you know minor trauma, you’re, you’re unlikely to have a major,
Unknown Speaker  13:23
you know, event where you’re having, you know, acute compression of your spinal cord.
Unknown Speaker  13:27
Now, have you just a little aside? There’s this text neck phenomenon. Have you seen this at all?
Unknown Speaker  13:36
Sure. I think that’s just, you know, this text neck is is just in the greater scope of 21st century living. So, we spend our days on the computer we’re on our phones in between, we’re basically always looking down and also as we age, our distance generate so your whole, you basically you’re focusing your whole, your whole body is is being pulled forward. And, yes, definitely a problem. And, you know, I, I talked to my patients about doing strengthening poses, specifically their posterior chain, so their extensive muscles, you know, working on flexibility but specifically with extension type activities because we tend to lose that naturally with age but even more so now in today’s society where all you know, our whole life is spent kind of crush over something.
Unknown Speaker  14:24
Can you give some examples of that? That sounds like something that is, is really great advice for human beings in general. And again, kind of the idea behind this podcast right, what what are the things that every doctor should know? That sounds like something every doctor should know. So what are some good exercises that we should
Unknown Speaker  14:46
maybe I can help? Yeah, so so anything where one thing that I tell a lot of patients is to do like a Superman, or basically if you you know, if you get a mad you put it on the ground, you lie in your stomach, and you put your arms out like you’re flying like this. Superman and then you basically you want to work on extending and lifting you know reaching your arms and your legs out and up as high as you can. And holding that for five seconds 10 seconds or you know doing or doing you know, doing set to that where you’re basically working on it on strengthening your extensors. That’s a really good one to do at home. If you have access to a gym I mean they have these these machines his boot him developer machines where you can go and you can you can also work on extension of your back of your neck that kind of thing. So the Superman is a good one you can also do it you know if you’re if you if you have a exercise ball, you can work on kind of, if you lean over the exercise ball with exercise ball in your stomach and you’re working on extending your your arms and your legs, you know, that kind of thing. I think it’s can be beneficial.
Unknown Speaker  15:47
So as a spine specialist when you are meeting with your patients and working on your electronic medical record, are you sitting on one of those balls?
Unknown Speaker  15:57
I wish no tonight unfortunately The Google ization of has not happened in medicine or no foosball tables or beer dispensers in the office, unfortunately. But I do tell patients so another thing to expand upon on top of just the Superman activities is yoga and polities. I tell everybody, I do it myself, I try and I tell all my patients to you don’t need to go too expensive. You don’t spend a lot of money you can go on YouTube, and just type in yoga exercises for your back. Just basic, the basic yoga poses like downward dog, Cobra, you know, cat cow, I don’t know how many Yogi’s are out there, but those are great exercises for your back and they all work on no flexibility, spine flexibility extensions.
Unknown Speaker  16:43
So I think it’s a it’s very beneficial.
Unknown Speaker  16:46
I think the classes also in terms of
Unknown Speaker  16:52
habit formation, right. I think I think going to those classes gives you a sense of accountability because you meet the other people there. Wait, where were you last week? So it gets you to keep going and then there’s a sense of community as well it’s Oh definitely definitely you can if you can incorporate that as part of your life and go a couple days a week I think dramatic improvement especially in patients chronic pain, you know, chronic
Unknown Speaker  17:19
you know, issues keratosis have their back and that gets certainly can be huge. But even if they can’t, you know, some patients don’t have the time or the means even putting on a video for half an hour, once or twice a week. But But definitely, if you can join a group and go to a class on a regular basis, I think patients will see dramatic improvements. So it’s rare to see to be honest with you. I say patients, you know, I tell them but, you know, it’s, it’s hard in today’s life, just to make time.
Unknown Speaker  17:45
Yeah, I hope to incorporate that into the podcast at some point and get some of these experts on habit development in here. So that when we do give advice to our patients, it can be in a way that is realistic. Stick where we can expect them, you know, it is a realistic expectation that they will take the advice because we want them to do all of these things, but how can we get them to do it is the challenge, right? We all want them to eat better and exercise more and sleep more and have less stress. And so but right but how do we actually get them to do it? You know, there’s this pervading idea that that we are not
Unknown Speaker  18:26
holistic,
Unknown Speaker  18:27
right? Like, right we have a sick care system where the health care so exactly, exactly, well,
Unknown Speaker  18:33
well put. And so it sounds to me if you’re recommending these things, for your patients that you are a holistic doctor to me because you are considering the whole patient and not just the one injury that you happen to be seen them for. So
Unknown Speaker  18:49
yeah, no, definitely. You know, it’s hard as a physician as well, when you’re, you know, push to see more patients and you have X amount of time with these patients and you know, it’s enough just to get the spine exam down. But I do try you know, I see a lot of patients, you know, with with metabolic syndrome that are obese you know, and, and that’s a lot of extra weight you know, if you’re if you’re every pound of weight over your ideal body weight in the daily biomechanics of going through your life can be up to four pounds extra on your spine. So don’t patients if you’re 10 pounds overweight, it’s like carrying a 40 pound backpack around. Imagine doing that all day your back would hurt. And these patients you know, you can do the math on patients are, you know, pretty, pretty heavy. So I asked them, you know, what do you what do you maybe you can, you know, try to cut out sugary drinks or try not eating after a certain time, small things, you know, it’s hard to go on a radical crash diet and they have a high failure rate but just being a little aware of how they can at least make some changes. And actually, in an upcoming episode, I’m going to be interviewing someone who specializes in obesity research, who will be talking to us about how we should be addressing that specific population, there was just a Huffington Post article going around around the my physician friends on Facebook about how bad doctors are about talking about obesity. And, you know, I think with regards that article is probably just a few standout callous individuals, I think most of us are saying things like you’re saying, right, like, trying to give them some advice that is reasonable and not discouraging, right. Like, you know, maybe not eating after nine o’clock at night. That’s a reasonable recommendation that that is easier for them to stick to as opposed to like, don’t eat carbs ever again, right? Like that’s really easy to lose 50 pounds I mean, it’s it’s a lot easier said than done. And I’ll say again, if you say in the wrong way, you can certainly get some poor online reviews for as a result, but is that it but I think if you say it in earnest, and you’re somewhat sensitive about a patient, understand, I may know piecemeal pitches, no one there, you know that they put it together. You know, being being obese being out of shape is, you know, one of the root causes of their back pain because it just makes sense.
Unknown Speaker  21:07
So, so let’s get back. So that’s for a later episode. I’m really looking forward to that, that, but I’m also really enjoying this interview. So Seth, let’s talk some more about some of the common concepts that you see. What would you say is the most common thing that you see something one of the most that you think would be useful to discuss?
Unknown Speaker  21:27
Well, I mean, again, I see obviously, all day long, I’m seeing neck and back pain again, just especially in this area is the usual it’s, you know, patient has neck or back pain and, and maybe they get to men’s ends or maybe, you know, and then they get an MRI and, and the MRI sounds terrible and they you know, and then they show up in my, my office, is there degenerative disc disease on an MRI, like, just if you
Unknown Speaker  21:53
just give me some statistic that you know, of,
Unknown Speaker  21:57
yeah, extremely, extremely common. I use the Patients age as the percentage. So if you’re 50 years old, you know, I took 100, healthy 50 year olds with no back pain at all and did them rise and then probably 50% would have significant degenerative this disease, if you’re at that number is 80%. You know, so So that’s sort of a rough thing. There’s some, there’s some studies to show but as a rough generalization, it’s your age is the percentage of patients your age, so they would have, you know, findings on an MRI.
Unknown Speaker  22:28
So those findings could be used to explain pain that’s there, but it’s not predictive of pain.
Unknown Speaker  22:34
Yeah, it’s a very good point. Very good question. And I’ll say, you know, makes makes the job tough sometimes, because, you know, it’s very common to see herniated discs. It’s very common to see degenerative disc bulging discs. And it’s, it’s not so easy. You know, in some cases, those are patients are in severe, you know, pain to the point where they need surgery for it. And in some cases, it’s an incidental finding where, you know, it was there already. And it’s just a muscle spasm. So it can be a challenge to, and some people for some reason, you know, feel it. pain receptors are different or whatever. But some patients are more sensitive to those to those changes, and some people are not. I think this was a very productive conversation and really appreciate you taking the time. Is there anything else that you wanted to discuss today that you think we might have missed? Yeah, I mean, just in general. So just to expound a little bit more on that visit. So you know, in general, if you’re a you know, 53 year old man and you pulled you back out, you know, shoveling snow and you ended up with an MRI, or likely not to a layperson even to another doctor. It’s going to sound terrible, that’s, you know, radiologists, you know, like to be thorough, and they like to describe everything and it’s going to see things like spondylitis is this creation, impingement. But really, you know, to tease out, you know, all that really the thing I when I went I, you know, obviously I try to read all my films, I look at all the reports examined the patient, I try to make it the most educated, you know, decision as possible. But at a glance when I look quickly at an MRI, what I’m looking for is things like stenosis and more central stenosis, like if there’s pressure on the canal on the on the in the middle of the canal where this where the spine runs down, if that if that’s being compressed, that can really be an issue if there’s any kind of obviously a fracture or a tumor that’s that’s a red flag for everyone but stenosis or significant you know, Mal alignment of his mind to spinal this thesis was whether we’re bones are slipping on each other. You know, I look for conditions where the nerve is compressed, because all that other stuff is is very common, and usually not not really a problem. Certainly not in the in the short term.
Unknown Speaker  24:50
Great. I really appreciate you taking the time to talk to me and talk to the audience. I think clearly polities in yoga now. We’ll have to find their way into my regimen somehow it’s not just going to be clean and jerk. And
Unknown Speaker  25:08
especially if you’re going to do create clean and jerk you gotta do some yoga employees in there as you get older. Well, you know, I can’t touch my toes. That’s a problem.
Unknown Speaker  25:18
It’s going to start catching up with me and clearly the Superman’s needs to find their way into my routine because myself and, you know, I’m sure almost all doctors would with the EMR even, you know, without the MRI dictate a lot of my notes, still hunched over my phone hunched over my computer, and you know what, we’re surgeons, hunched over our patients in the office and in the operating room.
Unknown Speaker  25:42
Yeah, your whole your whole life is spent in an inflection of your spine. So you definitely want to focus on the extension and try to try to keep that strength and mobility, very important.
Unknown Speaker  25:52
So all of us need to start doing the Superman before we go to bed. Maybe next,
Unknown Speaker  25:57
I want to see worldwide. I want to people doing Superman all those would be my wish tonight. All physicians in
Unknown Speaker  26:03
every everybody Superman minutes, right every night before bed.
Unknown Speaker  26:10
Yeah, that’d be that’d be I’d be out of a job where the light was busy.
Unknown Speaker  26:15
Maybe I don’t want people to do that. I think
Unknown Speaker  26:17
there’s a little conflict there.
Unknown Speaker  26:18
Okay. Well, thanks again. I appreciate you taking the time. It’s been a pleasure.
Unknown Speaker  26:24
Thank you so much. Thanks for having me.
Unknown Speaker  26:27
That was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts, or wherever you get your podcasts and write us a review. You can also visit us on facebook@facebook.com slash physicians guide to doctoring. If you are interested in being a guest or have a question for a prior guest send a message or post a comment.
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