01/11/2025
This is a video of a neurosurgeon discussing why he decided to quit his job performing spinal surgeries.
The answer- Spinal surgery often doesn't help because it doesn't actually address the root cause of the problem.
In this video, the surgeon explains the factors he observed that helped to determine whether someone actually got better, even before surgery was ever performed.
These factors include aspects of health that relate to physiological health, including nutrition, stress management, and an active lifestyle.
These factors are important because they impact the tissues capacity for healing, adapting, and thriving. The factors he describes also tend to support better musculoskeletal functioning from a general sense. A healthier body has a better capacity for healing, as well as better tools to support quality movement.
I have spent my 16 year career studying the root causes of musculoskeletal pain, and have had years of experience helping people who have failed surgeries, or helping people avoid surgeries.
There are a couple concepts that are important to understand further when considering the root cause of musculoskeletal pain.
1) Physiological Health
Physiological health (including the factors the neurosurgeon describes in his video) is not only essential for tissue healing capacity, but also impacts how the neurological and musculoskeletal systems work. In other words, physiological health can impact how the neuromuscular system is able to create stability and mobility. For example, if someone is acutely dehydrated, their physiology is not optimal to produce the neuromuscular stability required for optimal movement or even static postural stability and support. The number of physiological factors that can influence neuromuscular system function are as vast as the body is complex.
2) The Neuroimmune Axis.
The neuroimmune axis describes how the neurological system works together with the immune system. This synergy can determine not only the pain threshold, but the effectiveness of the inflammatory and healing response. It is important to assess the contributions of this factor in the overall understanding of the root cause of musculoskeletal pain. The neuroimmune axis can be highly affected by the state of the nervous system as it relates to stress. Stress drives the stress response in the body, which is essentially carried out by the sympathetic nervous system (aka fight or flight system.) The parasympathetic nervous system (aka rest and digest system) function is essential for recovery and healing. The immune system is deeply integrated with the nervous system. The inflammatory response is essential for healing. But when the nervous system is out of balance (sympathetic nervous system overdrive), the immune system can get stuck in a hyper inflammatory/pain sensitive state, without the ability to complete the healing cycle, which requires the rest, digest, and recovery magic of the parasympathetic nervous system (which is suppressed during sympathetic nervous system overdrive.)
3) Mechanical Factors in Musculoskeletal Pain
Lastly, I need to address the mechanical factors involved in musculoskeletal pain, as these factors are the ones I primarily address in my physical therapy practice. The body’s ability to create stability and mobility determine how force is distributed through the body. Appropriate mobility is crucial for force distribution and determines how much force is distributed through which tissues at any given time. Any given tissue has a certain capacity to absorb force. The body is incredible in its ability to heal, adapt, and strengthen, but there comes a threshold where force load capacity for a tissue is exceeded, healing capacity is breached, and tissue breaks down.
The body is designed to distribute forces so that no one tissue breaches its capacity to absorb stress. But when stability mechanisms and mobility are compromised (often seen when the body relies heavily on a limited number of compensatory movement strategies) excessive forces can be imparted to isolated areas, causing tissue stress overload and breakdown, leading to structural degradation and chronic pain.
Optimizing force distribution, by optimizing stability and mobility, (therefore increasing the number of efficient movement strategies) is an essential component of resolving musculoskeletal pain and optimizing musculoskeletal function and performance. Diagnosing the root cause of pain requires an ability to assess whole body movement and force distribution patterns. Assessing, diagnosing, and restoring optimal force distribution is the core of my physical therapy practice, and absolutely key to maintaining healthy joints and tissues.
In conclusion, the neurosurgeon is absolutely right. The tools he has learned often do not address the root of the problem. Spinal surgery can certainly be a helpful and essential tool in certain cases, but thinking it is the ultimate solution can often be misguided. True healing requires addressing the underlying factors; physiological health, neuroimmune function, and mechanical factors. By addressing these root causes we can achieve sustainable pain relief, improved quality of life, and enhanced performance, not to mention, avoid surgeries.
Here, I share my story about how I spent the last two decades of my life as a neurosurgeon who went through a mid-life crisis and got through to the other si...
