Dr. Nathan Kadlecek, PT
Is a physical therapist committed to providing high quality health information, largely focused on lower back pain and the gross overuse of diagnostic imaging, medication, surgery, low quality treatment methods, and the over-diagnosis of pain conditions. He's also a powerlifter, pain nerd, macro-scale thinker, and wants to help you think differently about pain, healthcare, and life.
Spinal stenosis is something that can be treated or managed conservatively in many cases.
Here's an excerpt from a 2016 Cochrane review, detailing their conclusions of a study comparing surgical vs. non-surgical care for spinal stenosis.
"We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis, and we can provide no new recommendations to guide clinical practice. However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment. No clear benefits were observed with surgery versus non-surgical treatment. These findings suggest that clinicians should be very careful in informing patients about possible treatment options, especially given that conservative treatment options have resulted in no reported side effects. High-quality research is needed to compare surgical versus conservative care for individuals with lumbar spinal stenosis."
As you can see, surgery should be a last option, not first line defense. Side effects reports were from 10%-24% whereas non-surgical treatment was 0% complication.
Do you or someone you know have spinal stenosis?
BFR is a great way to increase your training volume without having to add in a bunch of heavy heavy volume, particulalry if you are dealing with pain or injury associated with lifting heavier. If you can lift heavy, lift heavy, however this is one way to receive a similar training intensity to maintain your work capacity.
Have you used BFR before? What'd you think?
Ever heard of blood flow restriction training (BFR)? Essentially, some blood flow is restricted, the workout is harder at much lighter weights, and you can still realize hypertrophy and strength gains.
Who is this good for? Bodybuilders and powerlifters looking to increase volume but keep load and mechanical stress lower, older adults dealing with osteoarthritis who have a hard time performing heavy leg exercises due to pain, pre and post ACL tear for extra hypertrophy work on atrophied quadriceps.
There are plenty of other people who could benefit from BFR, too! Shoot me a message if you're interested in working with me, and getting some BFR training/rehab.
BFR is not approriate for everyone, of course, and if you can lift heavy without pain, then lift heavy. This will not necessarily help you get stronger if you're already able to do that.
"The quest for more success and status (for the sake of success and status) often leads to the slow erosion of meaningful relationships" - ME
A perpetually happy, exciting, pain free life. It seems like this is what we all want. There is a catch though... we don’t want to put in the work. There is another catch... we won’t always be happy, life won’t always be exciting, and pain will come and go.
I’ve been thinking about this quite a bit as of late. When reflecting on conversations I’ve had with friends, family, and patients, I recognize most people are trying to reach an idealized life without struggle or pain. This type of life is exulted on social media, TV, from our friend groups, even our family. Scroll for two minutes on Instagram and you’ll no doubt get bombarded with perfectly edited photos of people, homes, and other trinkets.
We want the perfect marriage, the perfect body, the perfect family, the perfect job, the perfect home. We are obsessed with perfect scores on tests, saddened when we are less than perfect. This also leaks over into our expectations of others. We expect others to be perfect, to be without fault, and when a mistake is made we ruthlessly jump to conclusions that they were acting out of malice. We expect perfection of others yet expect others to take us as imperfect. This obsession with perfection also ties into how we view success.
Success and wealth go hand in hand with this perfect life, so society says. Many of us want this success and wealth, however, I’ve observed two things: 1. We want wealth but are envious but also spiteful of those who have it, 2. We expect that if we had wealth, life would be infinitely better and we would be exceedingly more happy. It’s true, that people living in poverty would have a better life with more wealth, and increase in happiness, to a point. It is not true, that massive amounts of wealth lead to a greater and more fulfilling life. There are plenty of people who are wealthy and miserable, routinely logging 60+ hr work weeks and sacrificing everything they care about.
In the past couple years, I’ve interacted with hundreds of business owners and entrepreneurs, and individuals in the workforce who are so focused on building and growing their business, progressing in their career, and working seven days/week for months, sometimes years at a time. This sacrifice of time with family and friends often leads to burnout and the severing of the relationships that they initially got into business for. Many business owners got into business as a way to a better life for them and their family but it turned into an all consuming force that has wreaked or is wreaking havoc on their relationships. I see this all too often with professionals. The quest for more success and status (for the sake of success and status) often leads to the slow erosion of meaningful relationships. If you are this person, stop. Stop and read this paragraph again.
Why are you working so hard? Hard work, embracing struggle, and being persistent is certainly necessary for any type of success in this life, however, the priority should not be these things. Could you accomplish the same if you also maintained healthy relationships with your significant other, friendships, and family? (This question was rhetorical, of course you can). Hard work does not equal smart work. Let’s not be consumed by the struggle and the act of working hard. Let’s prioritize our relationships and the positive impact we can have on others. If we do this, we’ll likely be able to accomplish more than we ever thought possible and to live a life filled with meaning and purpose.
Nathan Kadlecek is a Doctor of Physical Therapy, health nut, powerlifter, and seeks to answer somewhat unanswerable questions.
The scapegoat for so much back pain.
Could a disc herniation be the cause of pain? Sure.
Could it be other things as well? Yep.
True symptomatic disc herniations are actually quite rare AND most people will be able to recover from these without surgery.
Many people think that in order to feel better the disc must "heal" or resorb. This is not always the case.
Many of us are actually living with disc bulges and herniations and we don't even know about it.
We don't need to fear herniations so much!
What are your thoughts? Have you had a disc hernaition in the past, were you able to recover from it? Would love to hear your experiences!
Get out there and MOVE.
If you look up all the national and international guidelines for management of osteoarthritis, the first thing is EXERCISE.
That is all. Have a great day!
Many Many Many people have a meniscal tear and don’t even know about it.
Similarly, many people who have knee pain, who receive an MRI often find out they have a meniscal tear.
In the USA we perform TONS of unnecessary meniscectomies (removal of portions of the meniscus) and I’ve seen way too many botched meniscetomies to ever recommend this, UNLESS there is mechanical locking of the knee which is not spending to non operative management.
There have been a few great research studies now documenting how surgery vs. sham surgery (fake surgery) have the same outcomes when it comes to menisectomies.
I’d highly recommend the clinicalathlete podcast, particularly he episode which talks about meniscal tears and surgery outcomes.
What are your thoughts? Ever had a meniscectomy?
There is a lot of fear which surrounds back pain.
Much of this is likely due to societal norms and the acceptance of false narratives pertaining to lower back pain.
If we know that 95%+ of lower back pain is not dangerous, then why do we have such a large swath of the population suffering with chronic lower back pain issues?
This is not to say that there are not some genetic predispositions for developing lower back pain, however how much CONTRIBUTION is biological vs. environmental?
Some of you reading this might be dealing with chronic issues and what I am not saying is that it’s all in your head, or, that you should just suck it up and get better.
Chronic pain is incredibly challenging to deal with and the best thing we know to do with this is to focus on meaningful activities, improve sleep patterns, manage stress, improve exercise habits, and potentially pharmacological management in more challenging cases.
What are your thoughts on this, anything to add?
If you’ve been following me for a while you’ll know what my position is on back pain and surgery.
It’s not that surgery is never an option, in fact, it can be very helpful for some individuals with specific symptoms that are not getting better with conservative management.
My problem with our current system is that people are still rushed into getting an X-ray or MRI when it is not indicated.
Patients, you also have a role to play in this as I’ve met MANY who demand they absolutely need an MRI to “find out the root cause.”
It’s not that simple and often may lead to worse outcomes if you get the imaging early due to various beliefs that may come out of receiving this imaging.
What questions do you have for me? Anything I missed?