The Health Factory Podcast

The Health Factory Podcast: Dr. John M. Lavelle, D.O. talks the importance of functional fitness!

Josh:
Hey guys. Welcome back to the Health Factory Podcast. This is Josh, and I’m here with Dusty Holden and Dr. John Lavelle.

Dusty Holden:
Good morning.

Dr. Lavelle:
Glad to be here.

Dusty Holden:
Yeah, it’s good to be back.

Josh:
Last time we talked about injury and then shockingly, that obviously gets a lot of feedback. There’s a lot of folks who have been in pain, a lot of folks who’ve been injured in the past, and then maybe that was what sparked them to either change their training or develop something different, or maybe that’s what turned them off in the first place? That’s what’s kind of led us to talking to Dr. Lavelle today. Real quick, can you explain to us your background in medicine? So, what kind of doctor are you? What do I need to know about what you do?

Dr. Lavelle:
Yeah, absolutely. So, obviously I specialize in spine medicine.

Dr. Lavelle:
So what does that mean? It means I kind of take care of anyone that comes to my office with neck, back pain. They’re looking for me to diagnose the problem, see what’s going on and how we can get them, if not pain-free, getting them moving and doing the things they want to do. To get to that point, I did obviously undergrad college for four years, then med school for four years, then four years of internship, residency. Just a lot of years studying books and dealing with a lot of different patients to end up to the point where I did one-year fellowship, just strictly in spine medicine, learning how to look at people really from a different standpoint than some people that do, whether it’s pain management and they deal with a lot of back pain or surgeons that deal with a lot of back pain.

Dr. Lavelle:
My fellowship really focused on an exercise-based approach to treating people with spine injuries or spine complaints. So from there, I’ve just really gone on a different direction, with that, using exercise as the focus of my treatment to help people kind of live the lives they want to enjoy and do the things that they want to accomplish throughout their life, despite having back pain or a back injury in the past.

Josh:
Gosh, there’s a lot there. There’s a lot to unpack in that. I think that me personally I want to know what was the original motivation to make you do something like that?

Dr. Lavelle:
I think it kind of started back in medical school. I’m an osteopathic physician. I guess I should have said that at the beginning. So, there are DOs and MDs. I went to med school to get my osteopathic medical degree.

Dr. Lavelle:
So, a DO, very similar to MD training. You just also learn a lot about it. You have to take extra class hours in musculoskeletal medicine. So, learn how to do hands-on, manipulative treatment called osteopathic manipulation, but also how to diagnose and truly put your hands on patients and see what’s going on with their neuromusculoskeletal system. While doing that, you would see a lot of patients in my rotations through different practices; whether it’s pain management or family medicine rotations, people would all come in with back pain. The number one thing they got was a little piece of paper prescription for pain management, pain medication. So here’s your oxycodone, your NSAID if it be, or some kind of treatment that way, or maybe it was physical therapy. But always just handing them something and say, go do this or go take that and the patients would always be coming back month to month and just not improving.

Dr. Lavelle:
So, I wanted to find a way or approach that would more successfully treat the problem, the underlying problem. Not just the symptom of back pain, but what truly was going on to cause that pain, and how could you effectively treat that so they could live a better life, not just manage their symptoms with a prescription for a medication.

Dusty Holden:
So, what drew you into like functional movement and strength training? Because with a lot of folks, they’re scared about that part. They feel like if they have a back issue that lifting weight is the last thing that you need to do or should do. So, how did you get involved in that side of training to where you saw, man, this is for everybody. It’s not for just athletes.

Josh:
Let me interrupt real quick, that we should probably say that doc’s a CrossFitter. That’s a pretty big deal that the reason is because you were a CrossFitter first, right?

Dr. Lavelle:
Yeah, absolutely. So, the reason I do CrossFit and that high, intentional, constantly varied functional movement, I love that saying, is because it works. I’m in the gym regularly or working out on my own regularly because I don’t want to have that chronic back pain. I want to be able to keep moving and doing what I’m doing today at 41 when I’m 91. How did I get to that point, thinking that was the answer? It was years of trial and error. Now I’m only 41, so when I say years, it hasn’t been that long.

Dr. Lavelle:
But starting my medical training at 22, so almost 20 years of seeing different ways of treating back injuries, back pain, and seeing how some that are successful, temporarily successful. Like I said, whether it’s medications, whether it’s surgery, whether it’s injections. Kind of seeing all those different avenues and then also seeing it compared with exercise. Keep people moving; don’t shut them down. Don’t just give them medication and tell them to rest at home. But what if you keep them moving? What if you keep them active? Yes, they have pain. But what if you ask them to kind of keep moving through it, to a point, where they can tolerate it, but keep staying functional. Seeing that they actually worked. People didn’t have setbacks. People were able to keep staying in work, keep going to their kid’s sporting events, keep doing their chores at home, keep moving without re-injuries without having those setbacks, and seeing that, that actually worked.

Dr. Lavelle:
Now you’ve seen over the last two, three years, the literature now coming out is bearing that out. You’re seeing studies showing that we want to keep people moving. We want to keep people active. They’re starting to look back at studies of people that did stay active versus those that didn’t, whether it’s former athletes or studies looking at people in the military that stay active versus those that didn’t. They don’t have an increased risk of injury, but yet they’re more functional. They’re able to keep doing everything they want. Some of them, yes, they still have some pain, but they’re able to keep moving versus those that completely shut it down. They still have pain, but they’re also not living their life. So it’s just kind of an option of which path do you want to choose?

Josh:
Doc, so, first off, first question is, do you remember [inaudible 00:07:04] that’s two questions, your first CrossFit workout? Do you remember that? Then second question off of that, how do you leap from your personal first CrossFit workout to your patients buying into CrossFit? Because to me, that sounds like a gigantic canyon in between what you did as your first CrossFit workout to what they would need to do for their first CrossFit workout.

Dr. Lavelle:
Good question. So, I’ll kind of take a step back to how I even got to thinking I would enjoy CrossFit. So, as I was going through medical training, always exercise and working out, but your traditional workout. I’d go to the gym, do bis and Tris, chest and back, legs and shoulders, that three-day cycle. Every week, doing that same thing. Maybe I got on a treadmill every once in a while, but it was just trying to work out.

Josh:
[crosstalk 00:07:59] Bicep, curls, baby.

Dr. Lavelle:
Somehow I still never got that big, but anyway. But always trying to keep moving and stay active, and similar with patients, trying to send them to physical therapy or just giving them a little sheet of paper saying exercise is good, but never a true instruction of how to do that. So, it was kind of a blank piece of paper when I left the office, and the trash can out the door, most of the time, the paper was sitting there. So, you can hand something to patients to tell them what to do, but you need to really show them how to do it, and show them a means to get to that end to keep moving. Especially if they’re in pain, they’re not going to want to do anything. They’re going to just blow you off and say, this guy just told me to exercise, I’m not going to listen to him.

Dr. Lavelle:
So, with my own experience of liking to exercise and then seeing the literature supporting that to treat back pain, I was looking for avenues of how best to implement that with my patients. The fellowship I did was at new England Baptist Hospital through Tufts University in Boston. My fellowship director there, Dr. Rainville, was a very big proponent of functional exercise, of movement. He had developed his whole physical therapy department around just that, lifting a crate off the floor. So basically, mimicking a deadlift, doing squat exercise, doing rows, doing pull-downs, still not very high intensity, but moving weight and resistance with patients with back pain.

Dr. Lavelle:
So, it was pretty revolutionary. Then him and a bunch of other doctors across the country have put together a lot of the research that we see coming out, really validating that approach and showing the success, especially when you compare it to traditional modes of treatment. As I mentioned, medications, injections, surgery, which those have exponentially gone up in their usage, but the improvement in patients hadn’t. Now we’re seeing that when you do add in the exercise, that does improve patient outcomes, pretty significantly compared to those other modalities.

Dr. Lavelle:
So, when I moved here to Knoxville, after my training in Boston and then being in practice in Texas, I was on the little league field coaching my kids and my assistant coach here, Dusty happened to own a CrossFit gym. I know he rolled his eyes at me when I said I was a spine doc, and he was nervous. He was like, Oh geez, this ain’t going to work, we’re not going to be friends. Actually, I said, well, that’s exactly what I need when he told me what he did, and his approach with people is just to keep them moving, getting them moving it, and he really explained to me what CrossFit really is.

Dr. Lavelle:
That’s a name you can throw out there, but what does that really mean? It’s just that functional movement. Keeping people, movement, mimicking things they do every day. So if you do a deadlift in the gym, what you’re doing every time you pick the groceries off the floor or get dishes out of the dishwasher. So, you do that every day, thousands of times a day, studies have shown, you do that hip hinge, that deadlift type movement. Similar with a squat, when you’re lifting up your children, if you have a newborn at home, you’re always doing that deadlift or squat activity to get them up.

Dr. Lavelle:
So, he said, well, why don’t you come out and take a look and see if this is kind of something you like and you enjoy. So, that’s the first things he’s had me do, was a deadlift with a bar, and I still have that initial video. I look at it, I say, Oh my gosh, I don’t want to say the words I think of myself when I see that initial video. But you start small with a very lightweight resistance of a 45-pound bar, and then you can really progress. That’ll transition to your day to day life. When you start lifting that at the gym, at home, you’re able to pick up your kids, you’re able to go to the grocery store and do those things. So, it really transitions good to doing things functionally in a gym makes you able to do the things you want to do outside of it at home. That was a long-winded answer, I know.

Josh:
No, that’s the perfect statement, though. Maybe this isn’t a question that we can actually answer, maybe it’s too philosophical, but why do you think that it’s revolutionary for people to move, to be able to fix things? To me, it sounds like, and again, tell me if I’m totally wrong and Dusty just interrupt me, but it seems like we have went the other way, where it’s been a lack of movement, that’s rest almost to treat things. Why is it revolutionary today, that movement is helping?

Dr. Lavelle:
Is the key. Well, back pain, as I mentioned in the beginning, is a symptom. So, that’s not the diagnosis. That’s the symptom of what people have. They come in, they complain of neck pain, complain of back pain. It’s like coming in and complaining of chest pain to your cardiologist. But you don’t just leave it at that. You dig in and find out what the actual problem is. So, is there a problem in the ligaments, the muscles, the nerves, the disc, is there a disc herniation? Is there arthritis in the back?

Josh:
So let me interrupt really quickly that, that doesn’t sound like an experience I’ve had with many doctors. Not to get you to speak poorly about others, but I don’t feel like I’ve had that conversation where somebody has actually asked me those questions. Are those typical questions that you ask, and you try to dive into each patient’s background history?

Dr. Lavelle:
That’s the job of a physician. If you’re not doing that, I don’t think you’re doing your job. So, the job is to find out what the problem is, and you do that by putting your hands on patients and asking questions. So, it takes time with patients. You’ve got to spend that time with them. Then you find out, do you need other imaging to do any diagnostic tests, x-rays MRIs, nerve conduction studies. Once you have all that, and it sounds like a lot, doesn’t take that much time in the office, and then you find out the treatment that works.

Dr. Lavelle:
It’s that functional movement that seems to work to keep people moving. If you put them on bedrest, then yes, you may quiet down their symptom of pain, but you’re not treating that underlying problem. Oftentimes that underlining problem, yes, there may have initially been an injury, but that’s rare. Usually, it’s their arthritis flared up for some reasons. Oftentimes we don’t know why. Only about 2 to 3% of the time is there an actual injury that causes the symptom of back pain. Usually, it’s more from age-related, degenerative change that, over time, catches up with people, and we want to get people back to moving.

Dr. Lavelle:
So, as long as we know, from what I just mentioned, determining the underlying cause that it’s safe to move, that’s what we want to do, because if you’re not moving, then you’re just sitting at home on the couch. You’re not living the life you want to enjoy. That’s where things compound. So, if we’re not out moving and we’re just sitting on the coach, not able to go to our children’s games, not able to go to the family cookout and we’re sitting at home on the coach in front of a TV.

Dr. Lavelle:
You see what’s on TV nowadays, nothing happy and enjoyable. What happens to us? We get sad, we get depressed, we get lonely. Then we get a neurological impact back into our system, and that heightens the pain response in our brain. So, then we develop chronic pain. So, if we don’t keep people moving, out and active, they’re going to be secluded inside and not doing the things they enjoy, not stimulating their brain, the chemicals in our brain that allow us to enjoy life, have fun. So, that’s really another big component. One, exercise, and those functional movements help treat the muscles, the ligaments, the tissue in our back. But also that movement helps treat our brain’s perception of pain. So, if we don’t keep moving and stay active, we’re going to compound that pain that’s down in the back in the structural tissues through our nervous system, heightening that pain response. So, you’re hitting it from a lot of angles by keeping people out and active and not home and resting.

Josh:
So, the vicious cycle is, I feel a little effected, so I rest. Then I consume social media, and that makes me worse and makes me hurt more. That’s where just about everybody’s at.

Dr. Lavelle:
Correct. And that’s what we’ve got to educate people on. You see people when they come into the gym or my patients that I send to you guys, when they come in, they’re often miserable. They have a lot of severe pain, but you guys slowly get them moving and active. They don’t have any setbacks. They’re able to keep doing it. But then they realize, I’m out and about with people. They’re socializing; they’re talking, their whole face blossoms up when they come in the gym. It’s an amazing transformation in these patients, and you can almost see them starting to enjoy life again, get their life back.

Josh:
So, that speaks to the workouts, the stuff, the tools, but it also speaks to the community. Like the community is part of the fix.

Dr. Lavelle:
Yeah, absolutely.

Josh:
Now, you said there was, how many would you say that come in, that you would not say movement is a thing? Out of everybody that’s in pain today, what’s the percentage do you approximate that should not be moving?

Dr. Lavelle:
It’s less than 1%, easily, if that. Okay. That’s a really, So if I see a hundred patients, I’d say it’s not even one out of those hundred [crosstalk 00:16:45] say don’t move. You’re looking for infection in the spine, meningitis, discitis, a tumor in the spine, cauda equina syndrome, which is a disc herniation near the end of the spinal cord or disc herniation or something compressing against the spinal cord causing myelopathy. Those are the things you really want to rule out before you just say yes, go do what you need to do, and go do the things you can tolerate. But most of those things, they’ve still got to move. They’re still going to want to live their life. So, it’s very rare that people aren’t going to get better by movement. It’s more of something there is acutely that needs surgical fix. That’s the things that you want to rule out before you just do that.

Josh:
That’s awesome. What it sounds like and correct me if I’m wrong, it sounds like I’m going to move, for most of us, it sounds like I need to move, but it also sounds like it’s not going to be very comfortable.

Dr. Lavelle:
Yeah, absolutely. Especially the first, you can say that to anyone, even if they haven’t been moving and they don’t have a back problem. If someone just starts to exercise, they’re going to be sore the next day. The hard thing with patients with back pain that may flare it up a little bit more, that movement the next day, but that’s nothing to be fearful of. Especially if they’re doing the movements and it’s not painful then and there, then I’m much less concerned. If it’s soreness the next day or it’s stimulated the next day, that’s to be expected, because we’re stimulating that nervous system to help it recover or what I like to tell patients, or we see in the literature, it’s called nervous system desensitization.

Dr. Lavelle:
You’re quieting down that nervous system response to that underlining issue in their spine, which is usually 90, 95% of the time, just age-related, degenerative changes in the disc, the joints, the tissue, the muscles. So, the nervous system becomes sensitized to those problems if they haven’t been moving. So, once you start moving, you’re going to flare up the nervous system, and it’s going to send that pain signal. [crosstalk 00:18:39].

Josh:
So, I’m going to be uncomfortable.

Dr. Lavelle:
Absolutely.

Josh:
I’m going to be uncomfortable when I work out. Be it If I walk in the door fit, or if I walk in the door less fit or even injured or with chronic pain, no matter what, it’s going to be uncomfortable. So, it’s okay to work out in discomfort.

Dr. Lavelle:
To put it another way, if there’s a CrossFitter leaving the gym [inaudible 00:18:59] the next day isn’t sore, they probably weren’t pushing themselves [crosstalk 00:19:03].

Dr. Lavelle:
But I always tell my patients, you’ve got to expect the first two weeks or so, it’s going to be sore. It’s going to be difficult, especially that next day or later that night after you work out, you’re going to flare it up some. That’s my job, to help them quiet it down and so I do injections. I do other things than just tell them to go exercise. All the other modalities I do, whether it’s to take an anti-inflammatory or to do an injection, that’s just more to quiet down that acute pain response to allow them to kind of progress with the exercise or the movement because that’s going to give them the longterm improvement. What a lot of people will end up doing is like I said, just giving them a new medication every month or an injection every two to three months. That’s not the answer because that’s just keeping them by and keeping them reliant on what I could provide them where it’s not truly fixing their problem.

Dusty Holden:
So, that would segue into the patients that you do; you get them on a protocol where they’re moving, and they’re exercising. Whether it be here or on their own, what would you say the success rate is for them in one, relieving some pain or maybe even getting completely out of pain, but mainly just getting to a point where they’re not having to come back in for those injections? How effective would you say that it is for people?

Dr. Lavelle:
Yeah. I would say I don’t have a statistic to throw out there, I’d be making it up, but virtually everyone. I can say that confidently, and I think we could have patients come in here and completely agree that their life is improved by doing that. Now, many of them are completely pain-free, especially the ones that are dedicated to it and want to keep up with that exercise. That kind of fits true with a lot of the studies, you do not need to have chronic pain if your underlying problem is age-related degeneration. Everyone gets degenerative discs. Everyone gets arthritic change. By our sixties and seventies, it’s almost a universal. I would say it is universal that everyone has arthritis in the back or disc bulges, disc herniations. But most of those people, up to 40%, have never had any back pain. So, we know you do not have to have pain just because you have those changes in your back.

Dr. Lavelle:
So, what is it about those people that never really have pain? They’ll have disc bulging, arthritic change. It seems to be how their nervous system responds to that. That’s the goal with the movement, to allow it to train that nervous system that it can cope or adjust to these degenerative changes without sending that pain signal constantly. So, I do think most people, if not all people, improve in some fashion. Now, sometimes they could come to me when they’re 65, they’ve had back pain for 30 years. I tell them, I don’t want to get you completely pain-free, I don’t know that that can happen once you’re to that point. But we can get you doing the things you want to do, going to your grandkids games, babysitting for your grandkids, and that’s my goal. I think universally if people keep moving and keep active with some kind of exercise program, they’ll get there. There’s no doubt in my mind.

Josh:
So, what I’m hearing though, is that as we, the majority of the patients, we call them athletes, the majority of the patients that you see, it’s mostly degenerative over time. So it’s age, it’s age-related.

Dr. Lavelle:
96, 98%.

Josh:
That’s huge. I think what we generally see here in the gym is it goes the other way. People start to work out less as they get older. You’re saying that it is more critical the older you get to lift weights, I’m doing quotation signs, to lift weights, to do functional training, to work out at some sort of intensity that’s obviously right for the athlete. Is that right?

Dr. Lavelle:
Absolutely. I think you need to do the combination of aerobic activity with strength training. A lot of people will do one or the other, and I think it’s the combination which is key. There’s no magic exercise. It’s doing something, moving some kind of weight with some kind of intensity where you’re increasing your heart rate, I think seems to be the key, from my experience with my patients. It seems to be what the literature is bearing out, too, from what we can see. Part of the issue is, as we get older, we get, as I said, degeneration in our discs, which are kind of the shock absorbers in between our vertebrae. Within our vertebrae, we have joints which connect them together, called the facet joints; we get arthritic change there. What we also get and which you almost never see on the MRI reports I get of the spine, or if people talk about, is the muscles in our back, we get normal age-related loss of muscle mass there.

Dr. Lavelle:
So, our muscles are made up of small individual muscle fibers, and we see those muscle fibers atrophy over time. We can see that in the muscles that stabilize the spine called the paraspinal muscles or the posterior chain of muscles that help stabilize the spine. So, if you lose that muscle mass, which we always see with time, but you can minimize that through strength training. So, if you don’t have those muscles there, those muscles obviously are doing something. So if you lose those muscles, then they’re not stabilizing the spine. So are you getting more pressure on those joints, more pressure on those discs, one to accelerate that arthritic degenerative change, but also if you keep getting pounding on joints that don’t have padding because of the arthritis, are those joints more likely to flare up and cause pain? So, that’s where I think that strength training is so important to maintain that muscle mass so they can work as cables to hold up the spine, take pressure off the spine, but also allow you to have the mobility, flexibility, and strength to do the things you want to do.

Josh:
Now, that’s pretty spectacular, that you’re in that realm. You said that maybe not everybody, but you would actually recommend patients to get with a coach and the coach to teach you how to do those things correctly. Like that’s part of your treatment.

Dr. Lavelle:
Absolutely. If there was a cure, I think that’s it. Now, like I said, the cure isn’t necessarily to be pain-free, the cure is to get you moving and functionally doing the things you want to do in your life so you can enjoy it and have fun.

Dusty Holden:
Improve quality of life.

Dr. Lavelle:
Yes. That’s my end game for treatment with patients. So, you may still have a little discomfort, but you’re able to do everything you want, that’s okay. The pain isn’t a warning sign that something’s broke or damaged or needs to be fixed. The pain is often something that you just got to kind of learn to kind of have on the side, but keep doing everything you want to do. That’s where coaching comes in because patients, if I hand them a piece of paper that says, do these ten workouts, one, it’s not going to be sufficient because your body’s going to plateau if you do the same ten things every day, but also how easy is it to put that paper aside and say, I’m too sore today, I can’t do this.

Dr. Lavelle:
But if you have someone there coaching you along, [crosstalk 00:26:01] one, it’s going to make sure you’re doing, exactly, you have that accountability, but also make sure you’re doing it appropriately. You don’t send a kid out to go play baseball and not have them coached. They’re not going to do very well—the same thing with exercise. You need to have someone there instructing you. So I use physical therapy a lot. I use personal training a lot because you need someone there to help guide them along.

Josh:
So, in our total treatment, I come to you, my back is hurting for what, for whatever reason, or whatever. Then you would prescribe or give me something, some sort of treatment to mitigate the pain. Then the whole cycle would be exercise, functional fitness, and then that’s what we would until I got to the point to where I could do the things that I wanted to do with life in general.

Dr. Lavelle:
Pretty much.

Dusty Holden:
The goal is to get the patient moving really as fast as you can.

Dr. Lavelle:
If you’re not moving and doing things, you’re not living an enjoyable life. No one wants to just be bed-bound, sitting in a chair or in a wheelchair. So, if you’re up and active, that’s going to give you fulfillment, and that’s the real goal.

Josh:
If I’m sitting at home and hearing this and never done any of this, how challenging is it, or how do we buy into that? Because we always do fitness and I feel like we take it for granted a lot of times. It’s part of our stress relief. It’s part of obviously making us feel good; it’s part of our community and our friends. But how do you get somebody who’s never done any of this to get this sort of buy-in? Is there a way that you do that’s different than Dusty and I, that actually get people to believe that? Because I feel like again, I’ve said this once; I don’t feel like every doctor is prescribing this. I’m not trying to be negative about others. Everybody has their method. But I feel like this is unique. How do we get other people to actually think it’s okay to be in a little bit of discomfort, to come into a gym that’s super intimidating and to be able to know that they can feel better on their own.

Dr. Lavelle:
I think it’s education because knowledge is power and trust. So, if someone walks into me that I’ve never met and I have slotted on my time, 15 minutes to spend with them, if I just read them a piece of paper and say, you have a disc herniation, we’re going to do an injection, and then you’re going to go exercise, why would they believe me? What’s the substance there? So you have to develop a rapport and a trust with patients, so they kind of understand what’s going on. The way I do that is by educating them. I kind of explain what’s going on. I look at the MRI and show them what’s actually there instead of just showing them the piece of paper, and I put my hands on patients, I actually do a thorough examination to make sure everything’s okay.

Dr. Lavelle:
Just in a short amount of time, just by doing that, patients will develop that trust in you and see that you care. Once they know that you care about them and you’re trying to educate them, then they’re going to want to do what you recommend because they kind of have that faith in what you’re telling them and how you’ve treated them, and they have that respect. So, they’ll start to buy into what you want to do, even if they think it’s outside the realm. Many patients come back to me and say, doc, you told me to exercise or go to CrossFit or do some kind of physical therapy, and I thought it was crazy because I was in too much pain, but I did it because you recommended it and it’s the best thing I’ve ever done. So, that’s really what I try to develop is, educate them, and build their trust so they’ll buy into it.

Dusty Holden:
How important do you think it is, because just listening to you talk, you’re around it. You’re doing this; you’re not just reading it in a book and then telling people, I think this is what you need to go do. You’re implementing it in your own life. So, how impactful do you think that is onto your patients, at least in the beginning, to get that buy-in? Because hearing you talk about it, you’ve got firsthand experience with it. You’re kind of setting the stage for them, [inaudible 00:30:16] I want you to understand this is what I’m doing because that’s really, I think when you’re sitting down with the doctor, a lot of times we don’t know, so we’re like, well, what do you think I should do?

Dr. Lavelle:
Yeah, I always try to. In med school they often would tell you, you don’t want to give too much information about yourself or be leery of giving your own personal examples. But I do that all the time with my patients. I let them know that this is kind of how I treat it. This is how I treat my family member. This is how I do treat my family member. They kind of really appreciate that to really understand that they’re just not a number in the waiting room that’s coming in to see you and going out just to keep the lights on, you’re really invested in them to make a difference and improve their life.

Dr. Lavelle:
That truly is, from the bottom of my heart, the goal is to get as many people as possible that would want to listen to be improved to live a healthier life. Part of that is movement and being active because if people are exercising and moving, that’s not just going to help their back pain; that’s going to help them neurologically, slow down dementia, Alzheimers, heart disease. You’re going to change a lot of people’s lives by moving, not just helping them with their back issues.

Josh:
That’s really interesting because every patient athlete that you’ve sent our way, every single one of them that’s talked to me about you, has said about building rapport. That’s almost the exact way they say it; he actually talks to me. I do get that that’s 100% of your motivation is to make them feel better, and I feel like that’s pretty cool, and that’s pretty profound. Just to give you a big compliment, I think that your patients know that, and that’s pretty special, man. I think that’s probably why we see so many of them here, like what Dusty was saying, I think if you told them, I don’t think they’d do it unless it’s comes from a spot like the way you deliver it, from a spot of doing it and a spot of caring.

Dusty Holden:
Well, I know just based off of the experience that I’ve had with some of your patients, there’s been moments where they’re at a real crossroad of, is this working? Is this the right thing for me? Then they see you in the gym, or they bump into you in the gym. I can remember those conversations afterwards of, wow, it’s so good to see him here doing these things. Because I think that’s just something that’s lost in today’s world is there’s so much information, and people just don’t know, is it what I should do? Is he telling me the right thing? Or maybe they’ve just been told so much, but I think there’s that moment where, when they see you doing it, that there’s a real buy-in, I think, that happens, and it kind of propels them to the next level.

Dr. Lavelle:
It’s fun when I am in the gym and see someone that was there, someone that was initially there and like myself could barely lift the barbell and now is in a class.

Dr. Lavelle:
Then at the end of the class, you’re both laying on the ground together on your back, barely catching your breath. That’s pretty special for me too, to see that. This patient now, as you guys say, an athlete, and we’re both in this together. That’s what’s fun is because I’m doing it too myself to stay healthy so I can do, like I said, everything I can for as long as I can. But I also think. Personally, the motivation for me to continue exercise is there’s heart disease in my family, there’s other neurological disorders, and I want to try and keep that at bay. So, I believe for myself, it’s the healthiest thing to do, and that’s why I want my patients to do it as well because I’ve truly seen the results.

Dr. Lavelle:
So, I want to be as passionate about it as I can and get the word out there to as many people as possible, that this will help, and you’ll be able to do much more with your life for a lot longer if you stay active and keep moving.

Josh:
With that, there’s a lot more we could go into, but I don’t know if it gets much more profound than that.

Dusty Holden:
I don’t think so [inaudible 00:34:42].

Josh:
So, unless you have something [crosstalk 00:34:45]-

Dr. Lavelle:
I will just say when you asked the first workout Dusty ever had me do, and it was Karen. But he cut it in half, so it was 75 wall balls, and I still hate wall balls to this day.

Josh:
Yeah, really, what a choice for the first workout.

Dusty Holden:
I was like, all right, big fella.

Josh:
Let’s do 75 of them. Okay. Well doc, I really appreciate you coming on to the show.

Dr. Lavelle:
That’s fine. We’ll have to do it again for sure.

Josh:
That was fantastic. Maybe after we hear some comments, we’ll be able to get back and get into specific subjects, but I really appreciate it guys.

Dr. Lavelle:
Sounds great. Have a good day.

Josh:
Thank you.

Dr. Lavelle:
Thanks for being on.