SPEAKERS
Doc Mok, Jacky Homme, Robert Trager

Jacky Homme
Well hello, hello, hello, Maximal Beings. This is Jacky P hosting. I am here with my good friend and experts Doc Mok here hosting. I am Jacky, I’m not a medical specialist. I am your layman. I’m here to talk with Dr. Trager, excuse me about the chiropractic practice. So, like I said, I’m just here just to be inquisitive, make sure that Doc Mok and Dr. Trager don’t go above our heads and keep things in lay terms. To you Doc Mok.

Doc Mok
What’s going on Maximal beings, Doc Mok here with Maximal Being fitness, nutrition, and gut health. As always, I am Doc Mok, I’m a therapeutic endoscopy, which is a GI doctor that does a lot of procedures related to the pancreas bile ducts and cancer. I’m also a functional medicine practitioner, and here in Cleveland, Ohio is Dr. Trager. Dr. Trager Welcome to the show.

Robert Trager
Thank you so much for having me here. I’m an honor, honor to be here, and I’m an avid listener of your podcast as well, and just for the listeners out there, I am a chiropractic physician at University Hospitals, and that’s actually how I learned of Dr. Mok who actually works here as well, and I’ve been here going on a year this summer, and I absolutely love it here and I’m a budding researcher as well and it’s just it’s a great environment to be just here. Just super happy to be here. Back to you.

Jacky Homme
Well, thanks, Rob. Well, we’re excited to have you here because I myself have plenty of questions about the chiropractic practice, and I just learned that’s not chiropractics folks, it’s chiropractic. So, 33 still learning, which is great for me.

Doc Mok
You cannot supplement your way to health. But there are things that we need to add to our lives that can maximize our pathway to wellness. The American diet is virtually devoid of omega-3 fatty acids, which play a major role in cardiovascular disease, gut permeability, and mental health. Personally, I take omega-3s every night and iHerb is the best place for clean, natural sources of supplements. I love the Zenwise omega-3 fatty acid supplement, which is free of fish burps, and good for the environment, head on over to maximalbeing.com/iHerb, that’s I H E R B and enter the code B as in boy, D as in dog, B as in boy, 5528, and receive 10% off your orders for all supplements. Maximize your supplements with iHerb.

Intro
Welcome to Maximal Being! A GI doc and ICU nurse break down the science so you can exceed your gut health, nutrition, and fitness goals. So let’s smash the bioscience, and optimize your health with your hosts, Doc Mok and RN Graham.

Jacky Homme
Give us a good high-level view of you know your practice, right? There’s a lot of folks out there who might have their thoughts of what you know someone in your position does and right and they just think about the cracking and, and all the facade but you know, what is it that you do and if you can break it down for us?

Robert Trager
Great. So chiropractors are what we call portal of entry providers, and some people would consider them primary care a lot of people do not, but either way, they are taking patients in without necessarily a referral for what we call neuromusculoskeletal conditions, primarily those of the spine, and they are using conservative treatment methods, mainly those with hands-on application, what we call manual therapies, and that’s where we’d consider back cracking or popping of joints, and more technically, we call that spinal manipulation or adjustments and as well as soft tissue techniques, and there’s a whole variety of different manual therapies out there stretching, exercises. We do dabble in nutrition and lifestyle and education as well. And as health care providers. First and foremost, we emphasize getting the right diagnosis we evaluate our patients trying to figure out what’s going on. We talk with them, we give them an accurate prognosis or tell them how long we think it will take for them to get better, and then we start treatment which oftentimes with chiropractic involves hands-on care and sometimes it does not, and it also involves things like diagnostic testing and referrals when needed. Yeah, back to you.

Jacky Homme
Well, well, that’s interesting, you bring up the diagnostic referrals, you know, me and I always thought, okay, you see a chiropractor after you have a traumatic event, right? You go, you have a car accident, or you trip and fall or if you’re like me lately, you just wake up and your lower back is just not happy with you is, are you more of a reactive, right? Or is your practice more reactive, you’re dealing with injuries and trauma, or, you know, if I was an athlete, and I was in great shape, right, you know, it won’t be able to come to you to, to kind of keep myself in tune?

Robert Trager
That’s a great question, and you’ll see a variety of different niches of chiropractors out there, and some of them will focus more on active athletes, things like that, and others are more looking at severe pathology, and I am lucky enough to have been in different practices where I’ve actually seen both. In my former practice, I was seeing a lot of athletes and doing what we might consider sports medicine, and working with people that are trying to perform better and trying to get rid of aches and pains. So, they can go do weightlifting or compete in athletic events, and now, I’m in a hospital setting, and we’re typically seeing more severe cases of people that are in chronic pain, people that have had surgeries on their back or considering to have surgeries, or they’ve been on opioids for a long time, and they’re looking for an alternative for pain relief. So, there’s really a mix out there as far as the patients that are coming to see chiropractors, and then also the different environments that chiropractors provide care. and it’s really, I think, it’s up to the patient to try to find a good fit as far as what kind of chiropractor they’re looking for, and also, it’s up to the chiropractor to kind of give an idea to their patients, what they excel in, and what they like to focus on as far as treatments, and I put out there that I work a lot with sciatic pain and low back pain, and that is probably one of the most common things I see. Because people read my biography, and they see that I work a lot with that. So, I do see that as a big population. But I still do see some athletes as well, and yeah, so the goal is to get people out of pain and also to achieve their goals and whatever those goals may be. It may be athletic; it may just be feeling good enough to play golf or walk down the street or play with their grandkids. So, whatever that is, back to you.

Doc Mok
You know, as a doctor, I think a lot of us think that chiropractic medicine is more of an anatomic field, right that you’re manipulating ligaments, bones, joints, musculature, but there’s so much that’s happening under the surface in terms of pain regulation. You know, nowadays, CBD has gotten so much press in terms of the pain pathways that CBD can modulate. But for the listeners out there, when your body has an injury, there’s this whole cascade of things that occur called inflammatory cytokines. Maybe some of you have heard that in terms of the COVID-19 virus, right. That’s what makes people so sick, and there are variations between people and their responses to injuries. And so, the same thing happens in terms of you injure a muscle while you’re powerlifting. Right? You have a different response than other people, and so Dr. Trager so kindly pulled an article for us actually looking at the effect of chiropractic medicine on these pain signals and your inflammatory markers. So back to you, Dr. Trager to talk to us about this article.

Robert Trager

Yeah. So thank you for bringing that up, and I’d like to actually touch on the history of the theories of chiropractic medicine, because as you so eloquently brought up, it’s not as simple as it may seem, and one of the first theories actually the first theory of chiropractic was that we are putting bones back into place, and we kind of jokingly refer that as the BOOP model the bone out of place model for chiropractic care, and it’s actually pretty common, and it’s really no surprise that people would have thought that because people all the time, I mean, when they say they tweak their back, they say my back went out, they feel like something actually goes out of place, and so it’s totally understandable to think in that way.

However, we know now that it’s much more complex than that, and although bones sometimes do go out of place, and we call that a spondylolisthesis. It’s not very typical, and it doesn’t explain all the cases that we see in all the different subsets of neck pain, back pain and headaches and all those things that respond to chiropractic care, and a lot of times the bones are actually not out of place at all, and we’re not really changing the position of the bones. So, there are some newer theories based around what we call more neurologically based and so what we’re doing when we manipulate the spine, we are stimulating a lot of these receptors, and there’s these specialized if you want to call them nerve endings in around the spine in high high density, in and around the joints and the muscle fibers, and we call those muscle spindle fibers. There’s also pacinian corpuscles, and ruffini end-organ and all these little special sensory organs that when we go in, and we’re doing any kind of manual therapy or manipulation on the spine, we’re actually stimulating those and they’re in a very, very high density, there’s more of those in and around the spine than let’s say your finger or something like that your leg, and it’s really highly involved in balance and awareness and position sense, and so when we manipulate or crack the back, we’re sending a barrage of input into those receptors, and that sensation kind of weaves its way up the nerves and goes into the spinal cord, and when it does that, it’s actually a lot of amazing things happen, and number one, those nerves give off little branches called interneurons, which will block or inhibit some of the pain fibers that are going up through the spinal cord as well.

So, it’s pretty amazing just when you adjust someone’s spine or manipulate the spine, you can reduce pain just from that, and there’s other things that happen too, I mean, range of motion, breaking up adhesions or joint fixations, and then, as Dr. Mok referred to, there’s this inflammatory or anti-inflammatory response to spinal manipulation as well, and that’s where this paper comes in. It’s called effects of spinal manipulation therapy on inflammatory mediators in patients with nonspecific low back pain, and this is actually a randomized clinical trial that was just published this year 2021, and they took patients with acute and chronic low back pain, and they compared them to a group that was controlled, healthy controlled, and each group got spinal manipulation, are over a successive period of time with multiple interventions, and they also had blood work drawn repeatedly, and the researchers found that with patients that had spinal manipulation, they had significantly lower amounts of inflammatory mediators in the blood, and so this is really amazing that they were able to find this, and people have been looking for blood markers for pretty much everything you can think of, for a long, long time, and now chiropractic and spinal manipulation is on there as well, and it’s, it’s hard It probably too soon to extrapolate too much from this one study, but it is really interesting that when we go in as chiropractors and we are doing manipulations on the spine, or the lower back the neck, we’re actually having this anti-inflammatory effect that goes through the whole body. So it’s pretty interesting and what that might mean, and I think it’s worthy of a lot of follow-up research. So back to you.

Jacky Homme
Dr. Trager, listen, I’ve got to pull my layman card here. I apologize. You use a lot of big words in succession, and I want you to kind of drill down in some of the things you said about that article, but also maybe expand a little bit. So, you know, you talk about spinal manipulation, right. I mean, I think a lot of folks, myself included, we have an idea what you know, chiropractor does, right? You twist to the you know, you hear the pops and you’re cracking but you know, what can go a bit deeper? What do you mean like spinal manipulation? Is it like one certain thing you’re doing? Or is it like a handful of different things or doing? Stretches? Exercise?

Robert Trager

Yeah, that’s a great question. So spinal manipulation is actually a pretty broad term and spinal manipulation has been used around the world for hundreds, if not 1000s of years. It’s a pretty broad term, and there’s different types. There’s what we call high velocity, low amplitude, where you’re putting a quick impulse or thrust into the spine, and that’s typically what’s producing the cracking or popping, all that is actually a release of little bubbles from the joints. As you reduce the pressure, kind of like when you open a soda or something like that. So, when you open the joint space, little bubbles come out and that’s where it cracks, and so that’s what’s happening with spinal manipulation. There are different types of spinal manipulation though, where you don’t have the thrust, it’s kind of more mobilizing or just gently pressing down repeatedly, and even certain types of traction could be spinal manipulation, where you’re kind of lifting and pulling on the neck, things like that, and chiropractors are probably the most common utilizers of spinal manipulation. We also have some physical therapists that do that we have osteopaths, some medical providers all around the world that are doing this, and so yeah, it’s pretty broad, and there’s other things too, we mentioned the stretching. That is, it depends who you say, because I actually like to incorporate a lot of the stretching in my practice, I think it helps to compliment the spinal manipulation, and really shut off some of the tight muscles that we find, which I think goes hand in hand with the chronicity of the pain, and I also do another technique called dry needling, which if you saw it, you might say, Oh, that’s acupuncture. It’s a little bit different, though. It’s not as holistic. It’s not as whole body, and it’s not the same kind of philosophy, we’re basically just going into a trigger point or a tight knot in the muscle, and trying to kind of break that up with a really thin needle. Yeah.

Jacky Homme
No, that’s okay. So that makes a lot more sense. When you’re saying spine manipulation, I was thinking you’re contorting people into little pretzels, and there’s like all types of things. But that makes a lot more sense. Quick question, actually, you mentioned the sound of that cracking in that popping, right that like, you know, and someone’s cracking their knuckles, or I mean, I’m sure you’ve seen on the internet, you know, these viral videos, like these people have had back problems, and they cracked their back and like, it’s the noise, you can hear it. yards and, you know, yards and yards away, right? Um, I guess it’s a twofer. Really. The first is, I always hear the urban legend, you crack your hands too much, and give yourself arthritis or, you know, you’re not supposed to be cracking your hands a lot or anything that much. I mean, is there any water to that? Or is that just, you know, people just making up stories?

Robert Trager
That’s great. I’m really glad you asked that. So, I think there’s some caveats to that. I don’t think that just cracking your joints will create arthritis. First of all, I mean, the concern that some authors or doctors or people that say don’t do that the concern that some of these people have is that you’re creating what we call a joint instability if you’re doing it repetitively, and people that do it multiple times per day, kind of out of a habit, they’ll crack their back or neck again, and again, and again. I mean, it adds up to 1000s of times, and we really don’t know what that’s doing. I mean, it’s not dangerous in most cases, but there have been some cases of people injuring themselves, doing especially self-neck manipulation, I think that’s if there’s one thing that I’d say don’t do, I’d say don’t do that don’t crack your own neck, especially aggressively, and there’s a big difference between just kind of stretching it and getting some pops versus really yanking on it. There are some things that I’d also say are extremely safe, and you’re most likely not going to hurt yourself, and that would be like foam rolling your lower back, and also just a lot of stretches. Like if you’ve ever seen people doing what we call press-ups where they’re on their belly, and they press up, it looks almost like you’re trying to do a push-up, but you can’t

Jacky Homme
My favorite.

Robert Trager
So that’s a really good stretch, and a lot of times the back will crack or pop during that as well. I know if I do that mine will crack and it feels good, and it’s safe in most cases. Back to you.

Doc Mok
So um, I’m you know, I have back pain. I’m walking into your office, walk me through the process from you know, check in to what are your first diagnostic steps, like are you ordering bloodwork testing? What’s the general approach?

Robert Trager

Well, the first thing that we do is just take a history, we talk to the patient, just see what’s going on, see what their symptoms are. There’s a lot in there with especially low back pain as an example, I mean, that feeds into the treatment, and it all depends on what the patient really says like people that they have lower back pain when they’re standing and walking, and they feel fine when they’re sitting. That’s typically what we call lumbar stenosis, it’s kind of a narrowing in the lower back, and sometimes it produces shooting pain down the leg, and that’ll influence treatment tremendously, because it’ll give us more of what we call flexion-based treatment approach where we’re having them hug their knees up, and the converse example would be like a discrimination, these people hurt them sitting so we’ll have them doing some more extension-based stretches, things like that.

So, we also want to know what medical history people have. I mean, do they have osteoporosis or on blood thinners and all those things will impact the type of approach that we use with our spinal manipulation and things like dry needling. It will also impact if we need to get testing. I mean, are they having numbness in our hands and feet, maybe they need to be 12, and things like that. I mean, have they had any blood work? Do they have a primary care that’s looking at these things, and then we go through, and we just do an examination and chiropractic examination has a lot in common with orthopedic and neurology examination. So we probably add in the spinal palpation, where we’re feeling the spine trying to see if anything stiff or basically locked up, but we check strength, reflexes range of motion, just basic things like that, we’ll do some special testing with people, and then oftentimes, we will get started right away with treatment, and we’ll talk with the patient, see if they’re comfortable with it if they have any questions, but oftentimes, that first day, if we have time, what we’ll do some treatment, and see how people respond, we call that a trial of care, and for most things, I mean, it’s very responsible to do a brief trial of care, see other patient responds and see what their feedback is and if they’re improving, and after that, you can determine if you need to get some imaging, and a lot of the patients that I’m seeing in the hospital setting, they’ve already had imaging, so I don’t have to order very much but out in private practice before. A lot of times, we were getting imaging not every time I mean, it’s actually a little bit of a red flag if you’re x-raying every patient because it’s just not totally necessary, and that’s something our profession has tried to cut back on. There’s this Choosing Wisely movement, which is kind of across all disciplines, but the American chiropractic Association has contributed to that, that we probably shouldn’t be x-raying every patient, and that’s something that’s kind of changing over the years. So, the diagnostic workup really depends. It’s individualized to each patient, but that’s the basic synopsis. Each treatment will vary in length, I mean, a lot of first appointments that I do are 45 minutes, maybe even an hour max, and some of these really complicated patients and shorter follow-ups or 15 minutes to a half-hour, I’d say. Yeah, back to you.

Jacky Homme
Okay, and you know, so that brings up another question. So, right, you, I come to you, right, I threw my back out golfing, because I’m a terrible golfer, and, you know, you put me on a plan, right, you do some spine manipulation, right, do some needling and kind of, you know, get my back, my lower back, you know, back to where it was before. You know, I, I feel like I can’t say the word pulled my back out anymore, because it’s not the right, you know, word passive phrase, but I mean, I guess you can kind of keep saying, like, that’s what everyone thinks of. Right is, I mean, is it something that you, like, Is it like, Is it like a cure? Right? Like, you say, okay, you know, I hurt my back, I see you for 10 sessions, right, once a week, for the next 10 weeks, and, you know, I’m like, Am I done? Like, and I graduate? Like, yep, I did it, you know, Doctor, you know, Dr. Tragers got me, I’m good. I’m going back to hitting the links, or do you think, you know, it’s important for folks to, you know, keep yourself in line, right, keep stretching up? Right. You know, do you couple it with, you know, exercises, right to? I know that we say, you know, there aren’t really bones out of place, but it’s strengthening, you know, my lower back something that I should consider and make sure, and also, just by the way, this is actual personal question because I did hurt my back last last summer so I figured it’s gonna help me and the listeners, you know, like, what does that look like, from your perspective is like, would you recommend folks to kind of stay on that plan of care?

Robert Trager

That’s a great question. And I’ll give you a general answer here. So for some patients, what we do it is a it is a fix, I mean, they walk out feeling better, they don’t have to come back. I mean, they might only come 1 to 3 visits, and they’re fine, and I feel like that’s more common, and people that are active people that are healthy, they don’t have a lot of comorbidities, they have strong muscles supporting their spine, they stretch, they do things on a regular basis for their health, and they’re not low in vitamin D, and all these things.

So that brings us to what are the patients that we can’t fix right away, and those are people that have maybe chronic symptoms, longer lasting symptoms, maybe they’re not as healthy, they’re not as strong or active or they’re debilitated in some way they have more complicated injuries or prior surgeries, and these people will have to work with them on an ongoing basis, and a lot of times what we’ll do is we’ll spread the visits further apart as they get better, and it might take us a while to really get where we want to be and to bring their pain level from severe down to moderate or a mild level, and a lot of what we do in this, aside from the hands on approach, the chiropractic, spinal manipulation, manual therapies, is trying to increase patient’s self-efficacy, and what that means is we’re trying to get patients to live a healthier lifestyle where they’re not as dependent on what we’re doing, and try to teach people things that they can do at home, I mean, very simple things like stretching, foam rolling, rolling on a ball, or just doing different exercises, and bird dogs and different things like that, and so we want to help people, but we also don’t want people to be 100% dependent on us, if that makes sense to feel good on a regular basis.

I think some people benefit from what we call maintenance care, and there actually is a study that was done on that, and I can mention that for the listeners if they want to hear it. It’s the Nordic maintenance care program, and that is another randomized control trial that was just published a couple of years ago, and this is done over in Europe, and what they found is that patients that we’re told to see the chiropractor every month, compared to patients that went as needed, the patients that went every month actually had much fewer days of back pain per year, and they only use two more visits per year. So, it was 12 visits compared to 10 visits, and the monthly kind of maintenance group, and they had a lot better outcome. So there actually is a time and a place to do what we call maintenance chiropractic care, and we don’t recommend it to everybody. I mean, we really don’t I mean, some people get better, they’re fine, but I see this as being people that have maybe a chronically stressful job or some kind of repetitive overuse, where no matter what you do, it seems like things are just going to get aggravated at some point again, so we try to have those people come in on some kind of basis, and that can differ from person to person, it could be every month, it could be every two months. It could be two, three weeks it, we really try to figure that out on an individual level. Yeah, back to you, Jacky.

Jacky Homme
And to you, Doc.

Doc Mok
Yes. So, you know, mom always told you like, sit up straight, watch your posture, otherwise, you’re going to be this like hunched over old man. Right? So, and I know, personally, so many of the listeners here may even be watching it on a computer right now and slouching. So, you know, wake up people.

Jacky Homme
Or I’m recording this podcast slouching.

Doc Mok
Yeah. But what role do you think people’s general posture? You know, obviously, with COVID people are working from home, they’re sitting in front of computers, you know, you’re gonna see a ton more people with lower back pain. What do you think the role of having proper posture can do in preventing lower back pain?

Robert Trager

Yeah, that’s a super, super great question, and I want to clarify that. Even though I feel posture is important, and there’s a lot of nuances there, some of the research has shown that it’s not as important as we thought, and it’s important in certain situations, in certain areas, and at the extremes, but there’s actually a wide range of what we’d call a normal posture, there’s a lot of variation and the human spine, and different changes in the curvatures, and things like that. Very few people have what we consider a perfect posture, but there’s a lot of variation in that, and so what I find is patients come in and say my posture is horrible, and I look at them, and I’m like, it’s actually not that bad. I think what matters more is regular movements, and also keeping the back strong, and that keeps the vertebrae nice and aligned, and prevents people from getting what we call this degenerative spondylosis where the vertebrae kind of slips a little bit, and as much as I say, they don’t go out of place, sometimes they do over time, and there’s something called creep. Like if you’re sitting in a chair for like two hours, the bones can actually kind of just get really slippery and just kind of shift like a millimeter or so, and that can be really painful as well, and then people go to stand up and then their back just really kills.

So, I think moving every so often, avoiding just these prolonged postures, and trying to keep yourself strong. Another thing that’s really emerged in this whole area of research is the what we call the multifidus muscle, and the multifidus muscle is a group of small muscles that line upright against the spine, and it’s the most important spinal stability muscle as preventing some of these small little motions in the vertebrae, and we look at a lot of MRI, especially in the hospital setting, and a lot of these people, that muscle is just almost gone. It’s just completely replaced by fat, what we call fatty tissue, or fatty replacement, or atrophy, and that muscle will just go away, and you can build that back doing back exercises and things like that. I’m a big fan of weightlifting when done appropriately, but people call core exercises things like planks and side planks and bird dogs and dead bugs, and all those things can help regenerate this multifidus muscle, and I think that’s probably the most important thing for posture, aside from some of the other back muscles and neck muscles, but that’s a big one, and that and just regular movement. So yeah, back to you, Doc Mok.

Doc Mok
Yeah. And I’m gonna kick it over to Jacky here in a second. But if I can have another excuse to strengthen my core and do some deadlifts then yes, so to you Jacky.

Jacky Homme
Yes. Build, be strong like bull, like Doc Mok’s calf muscles. I’m gonna make a point to bring up the calf muscles every episode. Anywho.

Doc Mok
They have their own gravitational pull.

Jacky Homme
It is true, actually. They attract a lot. Um, so speaking of posture, right? And he said, you know, everyone talks about the bad posture, and this actually brought up a question for me. Bed, right? Your bed, right? You sleep in your bed? Right? They say it’s a 3rd of your life, spend the money, and there’s the people who like the soft mattresses, the people who like a firm mattress, you see the commercials on TV, Tempur-Pedic. What’s your sleep number, and align your spine and everything? And my question is, I mean, is this a preference thing? Is it something you know, like, you know, is this something that we should be paying attention to? Right? Should we all be sleeping on a firm mattress or soft mattress? Or? I mean, is there any research or science behind it? What’s you know, what’s your take on that one?

Robert Trager
That’s a great question. Unfortunately, there hasn’t been a lot of research into this. There was one study that was done on patients with disc herniation, and the conclusion was, they should sleep on a firm mattress. However, disc herniation is basically a bulging or protrusion of the cartilage in between the bones of your spine, and a lot of times it hits a nerve, the idea that a soft mattress will kind of sag or dip, and then your spine gets a curve in it, and that can sometimes aggravate that disc herniation, or pinch the nerve more. So, you do want your spine to be in somewhat of a neutral position. Although it may not matter unless you have an injury or something going on. The other thing that I’ve noticed is people with what we call Greater Trochanteric pain syndrome or trochanteric bursitis where they have just a lot of tenderness on the outside of their hip, like kind of on the side of their waist near their butt area. Some people get really sensitive right there. And they do better with a soft mattress because they don’t like that kind of pressure point on the firm area. So, it’s kind of tough, especially when you have like husband and wife and maybe one has the disc herniation and one has trochanteric bursitis. So, what do you do? I actually recommend people get a firm mattress with a foam topper, which seems to kind of cater to both types of patients and kind of settles everything. Yeah, back to you.

Doc Mok
So, I think that we’ve been having an amazing conversation. We’re gonna have to go to a brief commercial break and then we’re going to be back with Dr. Trager. For more on chiropractic medicine. What’s going on Maximal Beings, it’s Doc Mok here. Many of you are returning to the gym now, but some are not going back. Regardless of what you plan, Rogue has got the right gear to fit your needs. I personally own a barbell set and love it. The Black Ops shorts are sweat-resistant, and flexible for getting deep in your squats, head on over to maximalbeing.com/Rogue for our referral link, order three items and they ship for free. And as usual, it’s Doc Mok, and I’m here to maximize your pathway to wellness. If you’re stuck at home and cannot make it to the grocery store, delivery may be the best way to stay clean and healthy. Instacart is the national leader in the direct-to-home delivery service with numerous major chains and food from smaller stores. You can get those local veggies sent directly to your doorstep, head on over to maximalbeing.com/instacart, and maximize your nutrition today.

Jacky Homme
Welcome back Maximal Beings. It is I, your layman, Jacky P, here with Doc Mok and Dr. Trager giving us some good insight on everything that has to do with the world of chiropractic, chiropractic medicine. I have some questions for you. And then, you know we’ll see where this goes. So, the first is what is your favorite exercise?

Robert Trager
I would say definitely the deadlift, I canceled my gym membership about seven years ago and just got a deadlift bar and just started doing that at home. I just love it; I think there’s ways to do it responsibly. I actually went to a school, a college, I don’t wanna say were to look at it when I was in high school, and there was a big sign on the wall that said, no deadlifting, and I actually laughed because I thought it was just hilarious that a gym would say that, and I decided that I was going to learn how to do this and then get decent at it and do it in a safe way if I’m going to be a chiropractor. So, I think totally there’s, there’s ways to do this, there’s ways to do squatting safely. And if you have the right kind of coaching and you have strength and gradually progress your way up there, you can be perfectly fine and healthy, and even positive for your back health. And get that multifidus nice as strong and get your bone density nice and strong. All those good things

Jacky Homme
Multifidus that’s the small muscles in your lower back, right.

Robert Trager
Right.

Jacky Homme
I can’t wait to tell someone that they, there, they got to work on their multifidus when they’re stretching at the golf course, I can’t wait. Perfect. Yeah, no. Yes, compound exercises are always great. Okay, now we’re gonna switch it over to the diet side of the world. What is the craziest diet that you have been on? Or tried or heard of, perhaps maybe from the patient?

Robert Trager
Oh, so the thing with me is, I have done a lot of different diets over the years, I think that I’ve not been on a standard American diet for over a decade at least. And so, I’ve tried a lot of different things, and it’s all been in the pursuit of health, and what I found works for me is very individualized, and it may not work for other people. Although along the way, I’ve picked up some probably general ideas, and that is avoiding things like processed foods and some of these artificial things that have really, no matter what I’ve done, those are kind of the fundamentals behind what I’m doing.

Jacky Homme
I can bet that your Omega-3 intake is probably pretty high.

Robert Trager
I just recently started actually some fish oil, although I’ve always liked seafood and I grew up in New England, and just eating seafood is one of my favorite things. scallops is my favorite food.

Doc Mok
I feel like the reason why Jacky’s saying that is because every episode Omega-3 come up, I mean, every single episode. I mean, if you’re not taking Omega-3 like you are missing out on a bajillion health benefits. I just listened to a lecture this weekend, just on Omega-3s, and learned even more than we’ve talked about on the show. So more coming on that

Jacky Homme
Ohh

Doc Mok

Yeah, but I totally echo a lot of what you’re saying. Like, I think that every person’s diet should be individualized for that particular person based upon your heritage, your genetics, the expression of those genetics and your individual biochemistry, and your microbiome. I mean, those are the four components to our lives that make every human being unique. Absolutely.

Jacky Homme

Yeah, yeah. It’s almost, you know, they say, don’t keep up with the Joneses, right? When it comes to like being fancy or being outside of your lane financially, but it’s also the same with your health and nutrition. You know, the three of us here, you know, we can maybe follow the same plan, but we’ll have very different results. So, everything should always be individualized, and three, question three, what is your favorite health book and why?

Robert Trager

So, after I graduated chiropractic school, I just bought a bunch of books and got them from the library and just started reading all these different health topics that things that I couldn’t really study because I was more focused on passing board exams and things like that, and one of the books I came across was something called Body By Science, and it’s written by Doug McGuff. He’s an emergency room physician. He came up with this workout program, which is supposed to be backed by research and evidence, and he has a lot of references in there, but basically, he tells people, you don’t have to work out every day, you don’t have to over-exercise, you don’t have to spend hours and hours in the gym all day long every day, and he has people working out twice a week doing big compound, high intensity, high weight motions, things like pulling, pressing, and then a leg pressing motion, and like, that’s what he calls the big three, and so that is a principle that I sort of adopted out of necessity. I mean, I don’t have a lot of time, I have kids, I have research for work, but also, I feel like that I’m still in pretty good shape, even though I only do high-intensity workout a couple times a week, and I think it is a little more designed for people that have on the go jobs like he’s an ED Doc, and I’m a chiropractor. So, we get some light exercise through the day anyways, it’s just a nice way to supplement that, but aside from that I am not just a workout person, that’s not all I do. I mean, I’ve read a lot of if you want to call them esoteric books, and this would get maybe honorable mention. One, one book I read a number of years back, it’s always kind of stuck with me is this concept of cycling, where you, you write down a list of things that you want kind of like goals, but it’s all imagery, and the goal is to come up with 20 things, and the first time I did this, I actually couldn’t think of 20 things that I wanted, which is kind of funny, but once you try it, it’s actually kind of hard, and then you cycle through the images of each of those things over and over and over again, it’s actually really tough. It’s like a mental exercise, and if you do that, then the idea is that it helps you kind of focus and get your mind in the right place for things that you want.

Jacky Homme
Ah, I’ve been keen on similar things like the, like the law of attraction, right? Like, I mean, I mean, in that thread, right, like a vision board, and no, I like that myself. I always, I believe in if you kind of keep your focus on what you want, and what do you want to attract or pursue, right, it will keep you even subconsciously on track to pursue those goals, and this may not happen immediately, but you know, you’ll do the right things that get you there in the right direction. Doc Mok.

Doc Mok
Yeah, and I would also add having somebody to hold you accountable. So, if you want that Ferrari, when do you want it? And how are you going to get there and have somebody say, where can I get in that Ferrari? I don’t really want a Ferrari but like just an example.

Jacky Homme
His calf muscles can’t fit in a Ferrari

Doc Mok
No, no it will never make it. I have one. One other question for you, and I feel like this is really valuable for the listeners is what do you do as your recovery regimen, not only like stretches, you have general stretches, but also what sort of supplements do you use as a part of your recovery regimen.

Robert Trager
That’s great. I currently take a multivitamin every day. It has a lot of different things in there. It’s free of allergens, it has methylcobalamin, has iodine, has trace minerals, selenium, I take magnesium powder, every day, I toss a teaspoon in my water bottle, and I take fish oil, and that’s it. It’s pretty simple. I don’t overdo it on the supplements, and sometimes I’ll go without all those things. I also take vitamin D on the weekend and I got it with K2, and I’ve been taking K2 for years, and this is a really interesting point, but keeping the spine healthy is super important as it pertains to vitamin D and vitamin K2 and a lot of people think K2 just clotting it’s not necessarily true, it actually upregulates the proteins and enzymes that build bone and deposit calcium in the bone, and it’s been associated with bone density, and I think that it’s super important for the spine and we don’t have as much research as we’d want, but I think what we’ll get there and it’s very safe to take unless you’re on something like warfarin. So, I actually take drops of that, and in Cleveland, we don’t get a lot of sun in the summer I will skip if I go outside a lot. I do stretch I do try to practice what I preach. I have a foam roller in my house, and a lot of nights I lie back on that, and my back will pop a few times and it feels good. I like to do hanging, hanging is actually really good for your back. Have a pull-up bar and it’s really great to just hang for like 5-10 seconds in the middle of a workout. You can do that a couple of times. Just let your body just completely relax. Sometimes you’ll feel your back pop, actually, I think my L5-S1, the lowest joint, will kind of open up and pop a little when I do that. It’s fun. let out some bubbles, and I try not to over-exercise. I think I mentioned the Body By Science I only work out a couple of times per week. I like to incorporate some different movements in almost like a dance, dancing with my kids, and just jumping around and being silly. I think that’s good. Spending time with my family. I like just laying out in the sun. Sometimes I don’t really burn very easily. I try not to get burned, though. Being in the ocean I think is great too, and I just love getting to the ocean when I can, that’s probably the most peaceful I’ve ever felt in my life is when I’m at the beach in the ocean.

Jacky Homme
I got; I agree. I still sleep. I started when my son was born, we used to put on ocean sounds to help him sleep, and I still put them on for myself because I feel relaxed, and yeah, I mean, I think everything you said was very important. Right? You know, your spine is like the foundation of your body. Right? You got to take care of your back, right? And making sure that you’re doing the right things because you don’t get another one. Right, You Don’t you know that you know, there are different types of surgeries and everything, but that doesn’t beat just taking care of your body now, so you don’t have to worry about it later. And you did also bring up one thing, which was the hanging, right to I guess that keeps the pressure and takes the pressure off your back when you’re hanging. I think that’s also something that a lot of folks should do. Because one, you can say you’re hanging around and keep it cool and stretch it back, but at the end of the day, right if Dr. Trager has said anything, right is self-care, right? If you are not for someone in the medical field like Doc Mok and Dr. Trager and you’re like me and you sit at a desk, 8 to 10 hours a day, right? You’re not building up your knee. So, you might need to work a workout a little bit more than these guys do because they’re on your feet all day, but at the end of the day as you can see right you know Dr. Trager basically brought up everything that we’ve mentioned in past podcasts right with the fish oil right OMG Omega-3 right and the magnesium all those elements or excuse me, those trace minerals that are good for you. So, it’s not one thing ever. It’s never just one thing it’s a multitude of small things that help take care of your body and your mind and make sure that you are being the maximal being right I haven’t come to that on purpose but it happened. Dok Mok

Doc Mok
Yeah, I mean it’s so it’s amazing how fast time can fly when you’re speaking with you know, such big brains in the field and all the camaraderie and community and I thank both of you for that. I totally agree with everything that was said today, you know, recovery, your joints, your bones, it’s something that causes people so much pain, so much distressed one of the most common reasons why people go to the hospital go to see their doctor go to see their chiropractor, and you need to take care of your back. It’s not sexy, you know, deadlifting 425 pounds is sexy, but it’s the after-effect. You need to spend that 5-10 minutes just foam rolling working on your back end take that fish oil, oh my Omega OMG Omega. So thank you both for an amazing podcast. This is a great discussion. Special thanks to Jacky P for being the host today, and thank you so much, Dr. Trager for you know all of your camaraderie I love co-managing patients with you because you just totally just take it to the next level and you care so much. It’s wonderful. So thank you both, and for all of you out there. If you have any other questions you can shoot us a line a [email protected] check out MaximalBeing.com. We have a ton of information on there, and if you want to get in touch with any of our experts, I’m happy to pass your questions along either on social media or at that email, and if you want a custom fitness, nutrition or gut health plan, shoot me a line. As always, I’m Doc Mok I’m here with Jacky P, and with Dr. Trager and we’re here to maximize your health.

Doc Mok
What’s going on Maximal Beings, Doc Mok here. If you haven’t done so already, leave us a comment and hit the subscribe button. Let your friends and family know, that way we can get the word out and continue to bash the bioscience.